Mediation Intake Summary {CAO SC 4-4}

MEDIATION INTAKE SUMMARY CAO SC4 - 4 2/1/2010 CAO SC 4 - 4 MEDIATION INTAKE SUMMARY Date of Mediation Date Case Filed: Mediators: Small Claims Case No. Plaintiff: Defendant: Address: Address: Day Phone: Day Phone: Evening Phone: Evening Phone: Please indicate with an X whether party prefers t o be called day or evening. TYPE OF CASE Landlord/Tenant Automobile Accident Property Commercial Dispute: Interpersonal Dispute: Other: Judgment sought by Plaintiff: SETTLEMENT SETTLED Terms: PARTIAL SETTLEMENT Terms: NOT SETTLED Who e nded the mediation? Plaintiff Defendant Mediators All Is party willing to be called for follow up information? Plaintiff Defendant Yes No Yes No (Please circle appropriate response) American LegalNet, Inc. www.FormsWorkFlow.com