Mediation Referral Or Request

MEDIATION REFERRAL/REQUEST DATE ______________ CASE # _________________ JUDGE _________________ We, the undersigned parties, agree (BOTH PARTIES MUST SIGN) to have the following disagreements mediated by the Monroe County Friend of the Court: 1. 2. 3. 4. 5. We further understand that any agreement reached by us will be filed with the court and is binding and enforceable. Both parties must appear at the time and place of the scheduled mediation before it will be heard. All mediations will be held either at 9:00 a.m. or 2:30 p.m on Tuesdays only. Please call the Enforcement Aide to coordinate date and time at 734-240-7180. The notice below will be returned to you with the confirmation date. _________________________________ Name of Requesting Party _________________________________ Address _________________________________ City, State, Zip _______________________________ Name of Other Party _______________________________ Address _______________________________ City, State, Zip ____________________________________ Referred by CONFIRMATION OF MEDIATION: MEDIATION IS SCHEDULED FOR ___________________________(CASEWORKER) ON TUESDAY, ________________ AT ________________. I CERTIFY THAT THIS NOTICE WAS MAILED TO THE PARTIES AT THEIR ABOVE ADDRESSES ON _____________________. ______________________________________ Enforcement Aide American LegalNet, Inc. www.FormsWorkflow.com