Early Mediation Program (EMP) Opt Out Form {M-ADR5}

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and address) FOR COURT USE ONLY TELEPHONE NO.: FAX NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MERCED 2260 "N" Street Merced, CA 95340 (209) 725-4100 PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: EARLY MEDIATION PROGRAM (EMP) OPT OUT FORM CASE NUMBER: (Check one): UNLIMITED CASE (Amount demanded exceeds $25,000) LIMITED CASE (Amount demanded is $25,000 or less) Assigned Judge: Case Category (please circle): I II III PLEASE NOTE: TO BE EFFECTIVE, THIS FORM IS TO BE SERVED ON ALL PARTIES AND FILED WITH THE CIVIL CLERK'S OFFICE WITHIN 120 DAYS FROM THE FILING OF THE COMPLAINT Case Name: __________________________________________________________ Case Number: ______________________ Party Making this Request: ________________________________________________________ The above Party hereby OPTS OUT of the Court's Early Mediation Program ("EMP"). ________________________ Date ___________________________________________ Signature [M-ADR5] [Rev. Feb. 2008] EMP OPT OUT FORM Page 1of 2 American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF MAILING (CCP1013(a), 2015.5) Superior Court of California, County of Merced I, the undersigned, certify (or declare) under penalty of perjury, under the laws of the State of California, that I am not a party to the within action; that a true and correct copy of EMP OPT OUT FORM was served on each of the persons listed below, by depositing such notice in the United States Mail or by placing the envelope for collection and mailing following our ordinary business practices or by Interoffice Mail, enclosed in sealed envelopes with postage prepaid. [List Persons Served Here] Executed this day in __________________________, California. Date: ___________________ By:_______________________________________ Printed Name [M-ADR5] [Rev. Feb. 2008] EMP OPT OUT FORM American LegalNet, Inc. www.FormsWorkFlow.com Pages 2 of 2