Limited Issues Settlement Conference (Request For) {CJ-D 114}

REQUEST FOR LIMITED ISSUES SETTLEMENT CONFERENCE Case Name Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court Division Divorce Guardianship Modification Other: Contempt Paternity 1. Enter Party information below. Name of Plaintiff or Petitioner: (Print name) Name of Defendant or Respondent: (Print name) check if representing self OR Information on Attorney for Plaintiff or Petitioner: (Print name) check if representing self OR Information on Attorney for Defendant or Respondent: (Print name) (Law Firm) (Law Firm) (Address) (Apt, Unit, No. etc.) (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) (City/Town) (State) (Zip) Primary Phone #: B.B.O. # Email: Fax #: Primary Phone #: B.B.O. # Email: Fax #: NOTE: At least one party must be represented by counsel. Both Plaintiff/Petitioner and Defendant/Respondent must agree to participate. 2. Enter the descriptions and dates of the last event attended and the next event scheduled. Last scheduled event attended: Next scheduled event: 3. Is there an active 209A Restraining Order between the parties in this case? If Yes, please provide the following: Court: Docket No. Date: Date: Yes No 4. Identify and provide a brief synopsis of all unresolved issues. (Please be very specific. Attach additional pages if necessary.) Description 1. 2. 3. CJD 114 (9/6/13) American LegalNet, Inc. www.FormsWorkFlow.com Estimate of time (in minutes) required before the hearing officer page 1 of 2 5. Please provide a brief synopsis of other related issues. 6. Conference date requested: (date) . (LISC = 1st Friday of every month.) . (date) If this date is unavailable, your second choice is: WE AGREE TO BRING A WORKING AGREEMENT WHICH HAS BEEN CIRCULATED AT LEAST ONE (1) WEEK PRIOR TO THE CONFERENCE. NAME OF COUNSEL REQUESTING CONFERENCE: Signature (Print name) NAME OF COUNSEL REQUESTING CONFERENCE: OR SELF-REPRESENTED PARTY WHO AGREES WITH THIS REQUEST FOR CONFERENCE: (Print name) Signature (Print name) (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: Email: Date request submitted: (date) Please submit a copy of this request to Jocelynne D. Welsh, Esq. by email at: jocelynne.welsh@jud.state.ma.us OR by fax at: 617-788-8995 CJD 114 (9/6/13) American LegalNet, Inc. www.FormsWorkFlow.com page 2 of 2