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Motion For Mediation Child Custody And Visitation Program Form. This is a Alaska form and can be use in Anchorage Local Community.
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Tags: Motion For Mediation Child Custody And Visitation Program, DR-405 ANCH, Alaska Local Community, Anchorage
IN THE SUPERIOR COURT FOR THE STATE OF ALASKA
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CASE NO.
MOTION FOR MEDIATION THROUGH
CHILD CUSTODY &
VISITATION MEDIATION PROGRAM
This motion is filed by (check one)
Mother
Father
Both parties
I ask the court to order the parties to participate in mediation through the Child Custody
and Visitation Mediation Program. In support of this request, I state as follows:
1.
The parties have at least one minor child and cannot agree on custody or
visitation.
2.
I understand that Alaska law restricts the court’s ability to order mediation if
domestic violence has occurred between the parties. I certify that:
a.
b.
3.
There is no domestic violence protective order currently in effect (no
Alaska court order and no order issued in another state and filed in
Alaska).
In addition, one of the following is true (check one):
No domestic violence has occurred between the parties.
Domestic violence has occurred between the parties, but mediation
should still be permitted because it is requested by the victim and the
victim is signing this motion.
I understand that the parties’ combined net annual income must be less than
$100,000 in order to participate in the program.
Mother’s net annual income:
$
Father’s net annual income:
$
(The above amounts should be the same as the “NET INCOME” amounts in the
parties’ Child Support Guidelines Affidavits. Estimate the other party’s net
annual income if that party has not filed an affidavit and the information is not
otherwise available.)
Page 1 of 2
DR-405 (3/12)(cs)
MOTION FOR MEDIATION
Civ. R. 100
AS 25.20.080
AS 25.24.060 & .140
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The party requesting mediation must sign below. If both parties are requesting
mediation, then both parties must sign. If domestic violence has occurred between the
parties, the court cannot order mediation unless the victim agrees (by signing this
motion, by filing a response agreeing to mediation, or by agreeing at a hearing).
Date
Signature
Print Name
Daytime Phone
Mailing Address
City
State
Date
ZIP
Signature
Print Name
Daytime Phone
Mailing Address
City
State
ZIP
If Motion Is Signed By Only One Party
If this motion is signed by only one party, the party who signs it must mail a copy of the
motion to the other party. If the other party is represented by an attorney, the copy must
be mailed to the attorney instead of to the party. The party who signs the motion must
complete the following certificate so the court knows that the other party has been sent
a copy.
CERTIFICATE OF SERVICE
I certify that on
a copy of
this motion was mailed to (print name of party or
attorney):
Signature:
Notice to Party Not Signing Motion
You have a right to respond to this motion. Your response must be filed with the court
and a copy mailed to the other party no later than ten days from the date shown in the
above certificate of service. Your response must state whether you agree to mediation
or do not agree. If you do not agree, describe why you believe mediation is not
appropriate. Include the case number in your response. A response form (DR-406) is
available from the court. If you fail to file a response, the court may grant the request
for mediation and schedule a mediation session.
Page 2 of 2
DR-405 (3/12)(cs)
MOTION FOR MEDIATION
Civ. R. 100
AS 25.20.080
AS 25.24.060 & .140
American LegalNet, Inc.
www.FormsWorkFlow.com
