District Court Denver Juvenile Court ___________________________ County, Colorado Court Address: In re: The Marriage of: The Civil Union of: Parental Responsibilities concerning: ______________________________________________________ Petitioner: and Co-Petitioner/Respondent: Attorney or Party Without Attorney (Name and Address): Case Number: COURT USE ONLY Phone Number: FAX Number: E-mail: Atty. Reg. #: Division Courtroom MOTION RE: EXEMPTION FROM MEDIATION/ADR ORDER (DOMESTIC RELATIONS CASE) The Petitioner and/or Co-Petitioner/Respondent request(s) an exemption from the Mediation/ADR Order in this case, for the following reason(s): The parties attempted mediation or ADR _________________________ (specify ADR process) on __________________________ (date) and believe that additional mediation or ADR would not be useful. The Petitioner or Co-Petitioner/Respondent is unwilling to enter into mediation services or dispute resolution programs because s/he is the victim of physical or psychological abuse by the other party. Mediation or ADR is not appropriate in this case because: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ______________________________________ Petitioner Petitioner's Attorney Signature, if any Date _____________________________________________ Co-Petitioner/Respondent Date ______________________________________ _____________________________________________ Co-Petitioner's/Respondent's Attorney Signature, if any CERTIFICATE OF SERVICE (Required if only one of the parties is filing the Motion.) I certify that on __________________________ (date) the original was filed with the Court; and, a true and accurate copy of the Motion re: Exemption from Mediation/ADR Order (Domestic Relations Case) 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 1307 R713 MOTION RE: EXEMPTION FROM MEDIATION/ADR ORDER (DOMESTIC RELATIONS CASE) © 2013 Colorado Judicial Department for use in the Courts of Colorado American LegalNet, Inc. www.FormsWorkFlow.com