Mediators Notice Of Acceptance Or Recusal To Court-Ordered Mediation {RI-ADR003}

SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE BLYTHE 265 N. Broadway, Blythe, CA 92225 MURRIETA 30755 - D Auld Rd., Ste. 1226, Murrieta, CA 92563 CORONA 505 S. Buena Vista, Rm. 201, Corona, CA 92553 PALM SPRINGS 3255 Tahquitz Canyon Way, Palm Springs, CA 92262 MORENO VALLEY 13800 Heacock St., #D201, Moreno V a lley , RIVERSIDE 4050 Main St., Riverside, CA 92501 CA 92553 RI - ADR 00 3 MEDIATOR ( Name, State Bar Number and Address) FOR COURT USE ONLY TELEPHONE NO: FAX NO. (Optional): E - MAIL ADDRES S (Optional): PLAINTIFF (S) : DEFENDANT (S) : CASE NUMBER: MEDIATION COMPLETION DATE: - ORDERED MEDIATION ( California Rules of Court, Rule 3.855(f); Local Rule Title 3, Division 2 ) Assignment: The court has assigned me to serve as the mediator in this case. Stipulation: The parties have requested that I serve as the mediator in this case. This Notice must be served on all parties and fil ed with a proof of service within fifteen (15) days of the Notice of Court - TO THE COURT AND TO ALL PARTIES IN THIS MATTER: A. ACCEPTANCE I agree to serve as the mediator in this case. The mediation has not yet been scheduled. The mediation has been set for: Date: Time: Place: B. RECUSAL I decline to serve as a mediator in this case. (Optional): Reason for recusal: C. THE MEDIATION WILL NOT BE SCHEDULED The parties state that the case has fully s ettled. Other Dated: Page 1 of 2 Adopted for Mandatory Use Riverside Superior Court Form RI - ADR003 [Rev. 06/01 /16 ] (Reformatted 01/07/19) ACCEPTANCE OR RECUSAL Cal. Rules of Court, Rule 3.855(f) river side.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF (S) : DEFENDANT(S) : CASE NUMBER: PROOF OF SERVICE BY MAIL FAX ELECTRONIC SERVICE (Must be attached to original document at ti me of filing) I, the undersigned say: I am over 18 years of age and not a party to this action . I am a resident of or employed in the county where the mailing took place. My residence or business address is: The fax number from which I served the documents is (complete if service was by fax): On ( date ): I served a copy of the paper to which this proof of service is attached, RECUSAL TO COURT - ORDERED MEDIATION , as follows: By United States Mail: I served the documents by enclosing them in an envelope addressed as follows: and ( check one ): depositing the sealed envelope with the United States Postal Service with the postage fully prepaid. placing the envelope for collection and mailing following our ordinary business practices. I am readily he same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with postage fully prepaid. By fax transmission: Based on an agreement of the parties to accept service by fax transmission, I faxed said document to the persons listed at the fax numbers below. No error was reported by the fax machine that I used. A copy of the record of the fax transmission, which I printed out, is attached. Names Fax Numbers By electronic service. Based on an agreement of the parties to accept service by electronic transmission, I caused the documents to be sent to the pe rsons at the electronic notification addresses listed below: Names Email Addresses I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME OF PERSON COMPLETING THIS FORM) (SIGNATURE OF PERSON COMPLETING THIS FORM) Page 2 of 2 Adopted for Mandatory Use Riverside Superior Court Form RI - ADR003 [Rev. 06/01/ 16 ] (Reformatted 01/07/19) ACCEPTANCE OR RECUSAL Cal. Rules of Court, Rule 3.855(f ) riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com