Name: ___________________________________ Address: _________________________________ City, State, ZIP: ____________________________ Daytime Telephone No: ______________________ Representing Self, Without a Lawyer ARIZONA SUPERIOR COURT, PIMA COUNTY REGARDING THE MATTER OF: SUPERIOR COURT CASE NO._________________ ASSIGNED TO:_______________________ ___________________________ Petitioner REQUEST FOR ORDER GRANTING OR DENYING REQUEST FOR MEDIATION and If a Spanish-speaking mediator is required please check. (Si necesita un mediador que habla español, favor de indicarlo aquí.) ___________________________ Respondent A Request for Mediation was filed with the Court and served on the other party. Proof of service has been filed with the Court and 20 days have passed. Check appropriate boxes: No Response was filed. Response was filed. IT IS REQUESTED that the Court issue its order granting or denying the Request for Mediation. ______________ DATE: ____________________________________________________________ Signature of : Petitioner Respondent OR Attorney for Petitioner Respondent File the original with the Clerk of the Superior Court and Mail a Copy to: Petitioner Respondent Attorney for Petitioner Attorney for Respondent Conciliation Court mediation-order.form CC0474 Revised 1.3.08 American LegalNet, Inc. www.FormsWorkflow.com