Certificate Of Mediation Or Alternative Dispute Resolution Compliance
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Certificate Of Mediation Or Alternative Dispute Resolution Compliance Form. This is a Colorado form and can be use in Domestic Relations Statewide.
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Tags: Certificate Of Mediation Or Alternative Dispute Resolution Compliance, JDF 1119, Colorado Statewide, Domestic Relations
District Court Denver Juvenile Court
________________________________ County, Colorado
Court Address:
In re:
The Marriage of:
Parental Responsibilities concerning:
______________________________________________________
Petitioner/Plaintiff(s):
and
▲ COURT USE ONLY ▲
Co-Petitioner/Respondent/Defendant(s):
Attorney or Party Without Attorney (Name and Address):
Case Number:
Phone Number:
FAX Number:
Division
E-mail:
Atty. Reg. #:
Courtroom
CERTIFICATE OF MEDIATION/ALTERNATIVE DISPUTE RESOLUTION COMPLIANCE
This certificate certifies that the parties to this case have complied with the court’s order to engage in
Mediation/Alternative Dispute Resolution (ADR). Please list all parties who participated in the Mediation/ADR.
1. _________________________________________
2.___________________________________________
3. _________________________________________
4. ___________________________________________
5. _________________________________________
6. ___________________________________________
7. _________________________________________
8. ___________________________________________
The parties listed above met with _______________________________ (name of Mediator/Arbitrator/Special Master)
on _____________________________ (date(s)) for the Mediation/ADR process checked below.
Mediation (ADRM)
Med-arb (ADRB)
ADR Settlement Conference (ADRC)
Special Master (ADRR)
Parenting Coordination (ADRG)
Settlement Week (ADRS)
Early Neutral Evaluation (ADRE)
Child Support Worksheet Conference (ADRW)
ADR other please describe (ADRO) ________________________________________________________
The following results occurred as a result of this Mediation/ADR process:
Case Fully Resolved (ADRF)
Case Partially Resolved (ADRP)
No Issues Resolved (ADRN)
ADR Inappropriate (ADRI) (ADR determined inappropriate by the Mediator/Arbitrator/Special Master;
reasons may include the existence of domestic violence, incapacity of a party, or other specified
reasons.)
Date: ______________________________
______________________________________
Signature of Party or Attorney
CERTIFICATE OF SERVICE
I certify that on _________________________ (date) the original was filed with the Court and a true and accurate copy of the
Certificate of Mediation/ADR Compliance was served on the other party by Hand Delivery E-filed Faxed to this number
___________________ or by placing it in the United States mail, postage pre-paid, and addressed to the following:
To: ______________________________________
______________________________________
______________________________________
______________________________________
(Your Signature)
JDF 1119 1/06
CERTIFICATE OF MEDIATION/ADR COMPLIANCE
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