SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY FOR CLERK’S USE ONLY Case Number: Name of Petitioner, ATLAS Number: and (if applicable) ORDER FOR REFERRAL TO MEDIATION Name of Respondent Based on the “Petition for Pre-Decree Mediation” and pursuant to Arizona Law, IT IS ORDERED referring this matter to Conciliation Services for screening to determine if Mediation is appropriate. If Mediation is deemed appropriate, it is further ordered that the parties participate in Mediation. The parties will be notified of the Mediation date and time through a separate minute entry. IT IS FURTHER ORDERED that a copy of this “Order for Referral to Mediation” and a copy of the “Petition for Pre-Decree Mediation “ shall be mailed immediately to parties who have appeared in this action. DONE IN OPEN COURT: . Judge/Commissioner of the Superior Court READ ME: If your order for referral to Mediation is signed by a Judicial Officer, Conciliation Services will mail an “Order to Attend Mediation” to both parties. WARNING! THERE IS A $200 FEE FOR FAILURE TO ATTEND THE MEDIATION! Additionally, the Court may make such orders as it feels are just, including granting the relief requested by the party who does appear. ©Superior Court of Arizona in Maricopa County August 13, 2007 ALL RIGHTS RESERVED ORD DRADM81f Page 1 of 1 Use most current version American LegalNet, Inc. www.FormsWorkflow.com