Name: Mailing Address: City, State, Zip Code: Daytime Phone Number: Evening Phone Number: Representing: State Bar Number: [ ] Self [ ] Petitioner [ ] Respondent ARIZONA SUPERIOR COURT, COUNTY OF YAVAPAI Case No. Petitioner ATLAS No. Respondent JOINT ALTERNATIVE DISPUTE RESOLUTION STATEMENT TO THE COURT Pursuant to Rule 66, Arizona Rules of Family Law Procedure, we hereby state the following, under penalty of perjury: 1. 2. [ ] The parties agree to participate in Alternative Dispute Resolution (ADR) and have selected the following ADR process: [ ] Arbitration [ ] Mediation [ ] Settlement Conference [ ] Other: a. [ ] The parties will use a private provider OR [ ] The parties request a program provided through the court. b. The person or company providing the ADR service is: c. [ ] a. b. c. The parties expect to complete the ADR process by , . The parties have been unable to agree on an ADR process. [ ] The [ ] Petitioner [ ] Respondent believe(s) that the following ADR process would be appropriate: [ ] The [ ] Petitioner [ ] Respondent request(s) a conference to discuss ADR. [ ] The [ ] Petitioner [ ] Respondent believe(s) that an ADR process would not be appropriate for the following reason: Date Petitioner Date Respondent Superior Court of Arizona in Yavapai County Jan. 2009 Page 1 of 1 Jt.ADR American LegalNet, Inc. www.FormsWorkflow.com