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:
1. That each of the following documents, exhibited with this request, is genuine.
[Here list the documents and describe each document.]
2. That each of the following statements is true.
[Here list the statements.]
Attorney for Plaintiff