1 2 3 4 5 6 7 8 9 10 11 12 13 Plaintiff(s)/ Movant(s), 14 v. 15 16 17 18 1. 19 as the: 20 (a) Mediator 21 (b) Alternate Mediator 22 (c) Successor Mediator 23 (d) Successor Alternate Mediator 24 2. 25 mediation assignment: 26 Form 706 Revised 11/09 American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES BANKRUPTCY COURT FOR THE CENTRAL DISTRICT OF CALIFORNIA In re Debtor(s). Defendant(s)/Respondent(s). ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) Case No. [Chapter ] Adv. No. MEDIATOR'S CERTIFICATE REGARDING COMPLETION OF MEDIATION CONFERENCE I was assigned to mediate this matter by order of this Court dated ; ; ; . I hereby certify that, to the best of my information and belief, the 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Form 706 (a) Settled (b) Did NOT settle 3. ; . If the matter SETTLED: (a) Did the matter settle prior to the mediation conference without a mediation conference being held? (b) If you conducted a mediation conference that settled, on what date(s) did the conference occur? (c) If you conducted a mediation conference that settled, who did you designate to prepare the settlement documentation? 4. If the matter DID NOT settle: (a) Was the matter dismissed by the Court prior to the mediation conference? (b) Did you conduct a mediation conference? (c) If you conducted a mediation conference, on what date(s) did the conference occur? . . DATED: (Name of Mediator) (Signature of Mediator) cc: Hon. Barry Russell Mediation Program Administrator United States Bankruptcy Court 255 East Temple Street, Suite 1660 Los Angeles, California 90012 2 Revised 11/09 American LegalNet, Inc. www.FormsWorkFlow.com