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Form 53-16

This form can be adapted for use by attorneys ad litem appointed under Tex. R. Civ. P. 109a.

NOTICE: THIS DOCUMENT
CONTAINS SENSITIVE DATA

See § 6 of the Introduction in volume 1 of this manual concern­ing protection of sensitive data in filed documents.

[Caption. See § 3 of the Introduction in volume 1 of this manual.]

Statement of Evidence

On [date] the Court heard this case.

Petitioner appeared in person and through attorney of record, [name]. [Name of party cited by publication], Respondent, was cited by publication. The undersigned attorney ad litem, a licensed attorney, was appointed by the Court to represent the interest of that Respon­dent and entered a general denial. The parties announced ready for trial. All witnesses were sworn, and the case proceeded. The following evidence was introduced:

Detail all proof sustaining the affidavit for citation by publication and showing service.

Detail all elements of proof necessary to support all findings in the decree and to sustain all relief granted.

The following exhibits were introduced, made a part of the record, and filed: [list exhib­its introduced].

APPROVED on ___________________________________.

   
JUDGE PRESIDING

I have read the foregoing and agree that it accurately represents the evidence introduced at the hearing described above.

   
[Name]
Attorney Ad Litem
State Bar No.:
[Email address]
[Address]
[Telephone]
[Fax]

   
[Name]
Attorney for Petitioner
State Bar No.:
[Email address]
[Address]
[Telephone]
[Fax]

Add signature lines for any other attorneys or parties to the suit.