CAUSE NO. ______________

______________________________	§	IN THE DISTRICT COURT
	§
______________________________	§	394TH JUDICIAL DISTRICT
	§
______________________________	§	___________________ COUNTY, TEXAS

STATEMENT OF COMPLIANCE TEXAS FAMILY CODE SECTION 107.004

I am the Attorney Ad Litem for the child[ren] the subject of this suit. I hereby certify that I have complied with the requirements of the Texas Family Code Section 107.004 by meeting the child if the child is four years of age or older, or with the individual with whom the child ordinarily resides if the child is younger than four years of age, on the following dates since the prior hearing on this case:
Date		Time		Manner			Participants

													
													
I also met or spoke with the following persons regarding the child/placement: [CASA, caseworker, placement, etc.]
Date		Time		Manner		Participants

						Respectfully Submitted,

						[SIGNATURE BLOCK]

							Attorney ad Litem for the following children