Request For Pre-Decree Mediation {DRADM11f}

Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: ATLAS Number: Lawyer's Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR FOR CLERK'S USE ONLY Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Case Number: Name of Petitioner Current Judge: Name of Respondent REQUEST FOR PRE-DECREE MEDIATION We do not agree about the custody and/or parenting-time issues involving our child(ren) and I ask that Conciliation Services set a mediation of the issues, based on the following: 1. Check one box only. Divorce Pending: My spouse or I have filed papers with the Court for divorce or legal separation. No final orders about legal decision making (custody) or parenting time have been entered by the Judge. OR Paternity Pending: One of the parties has filed papers with this Court to establish paternity of the child(ren). No final orders about legal decision making (custody) or parenting time have been entered by the Judge. OR Other (describe): 2. 3. Check one box only. We have not participated in mediation OR We have participated in mediation before. Describe the disagreement. Be brief and specific. (The disagreement must involve the custody and/or parenting time of your minor children): 4. Information About Other Party: Name: Address: City, State, Zip code: Telephone Number(s): Attorney (if known): Date: Signature of Person Submitting Request for Mediation / NOTICE TO BOTH PARTIES: If your order is signed by the Judicial Officer, Conciliation Services will mail an "Order to Attend Mediation" to both parties. WARNING: FAILURE TO ATTEND MAY CARRY A $200 FEE. ©Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED PME DRADM11f-062916 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com