{"status":"success","response":"<div id=\"custom_forms\">\n\n<div class=\"report_row\" id=\"custom_field_row_1\"><h4>Numero  de muertos <\/h4><input type=\"text\" name=\"custom_field[1]\" value=\"\" id=\"custom_field_1\" class=\"text custom_text\" \/><\/div><div class=\"report_row\" id=\"custom_field_row_2\"><h4>Protagonistas (victimas)<span class='required'> *<\/span> <\/h4><table border=\"0\"><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[2-0]\" value=\"Ejercito\" id=\"custom_field_2\" \/><label for=\"custom_field[2]\" > Ejercito<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[2-1]\" value=\"Fiscalia del Estado\" id=\"custom_field_2\" \/><label for=\"custom_field[2]\" > Fiscalia del Estado<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[2-2]\" value=\"Policia Municipal\" id=\"custom_field_2\" \/><label for=\"custom_field[2]\" > Policia Municipal<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[2-3]\" value=\"Ciudadanos\" id=\"custom_field_2\" \/><label for=\"custom_field[2]\" > Ciudadanos<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[2-4]\" value=\"Zetas\" id=\"custom_field_2\" \/><label for=\"custom_field[2]\" > Zetas<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[2-5]\" value=\"Cartel del Golfo\" id=\"custom_field_2\" \/><label for=\"custom_field[2]\" > Cartel del Golfo<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[2-6]\" value=\"Criminales no identificados\" id=\"custom_field_2\" \/><label for=\"custom_field[2]\" > Criminales no identificados<\/label><\/span><\/td><\/tr><\/table><input type=\"hidden\" name=\"custom_field[2-BLANKHACK]\" value=\"\"  \/>\n<\/div><\/div>"}