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[Attorney name] [Address] [Telephone number]

Attorney for [e.g., Plaintiff], [name]

xxx Court, County of xxx
[xxx District]

xxxxxx ) No. xxx
Plaintiff(s) )
vs. ) STIPULATION TO AGREED FACTS
)
xxxxxx )
Defendant(s) )
__________________________)

The undersigned agree (1) that this action may be tried by this Court [or by a commissioner or judge pro tem of this Court] without a jury and (2) that judgment may be rendered on pleadings filed in this action and on the following statement of agreed facts, which serve as a substitute for evidence of those facts:

[State agreed facts].

Date: xxx

______________________ _____________________
[Typed name] [Typed name]
Attorney for [name]

_______________________ _____________________
[Typed name] [Typed name]
Attorney for [name]

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