Plaintiff A.B. requests defendant C.D. within .... days after service of this request to make the following admissions for the purpose of this action only and subject to all pertinent objections to admissibility which may be interposed at the trial:
[Here list the documents and describe each document.]
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Attorney for Plaintiff
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Address
Tit. 25, ch. 20, APPENDIX OF FORMS, form 21, MCA