0(',$725 (Name, State Bar number, and address)  7(/(3+21( 12 Court Use Only )$; 12 (Optional) (0$,/ $''5(66 (Optional) SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE Banning -  1 $OHVVDQGUR 5RDG %DQQLQJ &$  Hemet -  1 6WDWH 6WUHHW +HPHW &$  Indio -  2DVLV 6WUHHW ,QGLR &$  Riverside -  0DLQ 6WUHHW 5LYHUVLGH &$  Temecula   &RXQW\ &HQWHU 'ULYH %OGJ &  6XLWH  7HPHFXOD &$  3/$,17,))6 &$6( 180%(5 '()(1'$176 MEDIATOR’S NOTICE OF ACCEPTANCE OR RECUSAL TO COURT-ORDERED MEDIATION &DOLIRUQLD 5XOHV RI &RXUW 5XOH I /RFDO 5XOH 7LWOH  0(',$7,21 &203/(7,21 '$7( $VVLJQPHQW 7KH &RXUW KDV DVVLJQHG PH WR VHUYH DV WKH PHGLDWRU LQ WKLV FDVH 6WLSXODWLRQ 7KH SDUWLHV KDYH UHTXHVWHG WKDW , VHUYH DV WKH PHGLDWRU LQ WKLV FDVH 7KLV 1RWLFH PXVW EH VHUYHG RQ DOO SDUWLHV DQG ILOHG ZLWK D SURRI RI VHUYLFH ZLWKLQ ILIWHHQ  GD\V RI WKH 1RWLFH RI &RXUW$VVLJQHG 0HGLDWRU RU QRWLFH RI WKH SDUWLHV¶ VWLSXODWLRQ WR WKH PHGLDWRU TO THE COURT AND TO ALL PARTIES IN THIS MATTER: A. ACCEPTANCE. , DJUHH WR VHUYH DV WKH PHGLDWRU LQ WKLV FDVH 7KH PHGLDWLRQ KDV QRW \HW EHHQ VFKHGXOHG 7KH PHGLDWLRQ KDV EHHQ VHW IRU 'DWH 7LPH 3ODFH B. RECUSAL , GHFOLQH WR VHUYH DV D PHGLDWRU LQ WKLV FDVH 2SWLRQDO 5HDVRQ IRU UHFXVDO  C. THE MEDIATION WILL NOT BE SCHEDULED 7KH SDUWLHV VWDWH WKDW WKH FDVH KDV IXOO\ VHWWOHG 2WKHU 'DWHG 0HGLDWRU V 6LJQDWXUH ,QIRUPDWLRQ DQG IRUPV DUH SRVWHG RQ WKH $'5 ZHEVLWH ZZZULYHUVLGHFRXUWVFDJRYDGUDGUKWP 5,$'5 5HY  American LegalNet, Inc. www.FormsWorkFlow.com PROOF OF SERVICE BY F MAIL F FAX F ELECTRONIC SERVICE (Must be Attached to Original Document at Time of Filing) Case No. I, the undersigned, say: I am over the age of eighteen years and not a party to the within action or proceeding. My residence or business address is , California. The fax number from which I served the documents is (complete if service was by fax): On the day of , I served a copy of the paper to which this proof of service by mail is attached, MEDIATOR’S NOTICE OF ACCEPTANCE OR RECUSAL TO COURT-ORDERED MEDIATION as follows: F By United States mail. I deposited said copy enclosed in a sealed envelope with postage hereon fully prepaid, in the United States Postal Service mail box at the City of _____________________, California, addressed as follows: F By fax transmission. Based on an agreement of the parties to accept service by fax transmission, I faxed the Mediator’s Notice of Acceptance or Recusal to the persons listed at the fax numbers below. No error was reported by the fax machine that I used. A copy of the record of the fax transmission, which I printed out, is attached. Names F Fax Numbers By electronic service. Based on an agreement of the parties to accept service by electronic transmission, I caused the documents to be sent to the persons at the electronic notification addresses listed below: E-mail Addresses Names I certify (or declare) under penalty of perjury that the foregoing is true and correct. Executed on , at , California. ________________________________ (SIGNATURE) PROOF OF SERVICE BY MAIL, FAX, OR ELECTRONIC SERVICE American LegalNet, Inc. www.FormsWorkFlow.com