Name: Mailing Address: City, State, Zip Code: Phone Number: Representing: [ ] Self [ ] Petitioner [ ] Respondent ARIZONA SUPERIOR COURT, COUNTY OF YAVAPAI Case No. Petitioner/Plaintiff ATLAS No. Respondent/Defendant JOINT ALTERNATIVE DISPUTE RESOLUTION STATEMENT TO THE COURT Pursuant to the Arizona Rules of Family Law Procedure, we hereby state the following, under penalty of perjury: 1. [ ] The parties agree to participate in the following Alternative Dispute Resolution (ADR) process and: a. have selected the following ADR process: [] Arbitration [] Mediation [] Settlement Conference [] Other: b. [ ] The parties will use a private provider OR [ ] The parties request a program provided through the court. c. The person or company providing the ADR service is: d. [] 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: 2. Date Date Copy [ ] mailed Name Address Fax number by [ ] hand-delivered Petitioner Respondent [ ] faxed to the opposing party or counsel at on date Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com