JDF 608 R 8/17 MOTION RE: EXEMPTION FROM MEDIATION/ADR ORDER District Court Denver Juvenile Court County, Colorado Court Address: In re: The Marriage of: The Civil Union of: Parental Responsibilities concerning: Petiti oner/Plaintiff(s): and Co - Petitioner/Respondent/Defendant(s): COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom MOTION RE: EXEMPTION FROM MEDIATION/ADR ORDER The P etitioner/P laintiff(s) and/or Co - Petitioner /Respondent /Defendants(s) request (s) an exemption from Mediation/ADR in this case, for the following reason(s): The parties attempted mediation or ADR (specify ADR process) on (date) and b elieve that additional mediation or ADR would not be useful. The P etitioner/Plaintiff or Co - Petitioner/Respondent/D efendant is unwilling to enter into mediation services or dispute resolution programs because s he /he is the victim of physical or psycholo gical abuse by the other party . Mediation or ADR is not appropriate in this case because: By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. Petitioner / P laintiff Date Co - Petitioner/Respondent/ Defendant Date Petitioner / P laintiff C o - Petitioner/Respondent / Attorney S ignature, if any CERTIFICATE OF SERVICE (R equired 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 was served on the other party by: Hand D elivery 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 American LegalNet, Inc. www.FormsWorkFlow.com