UNITED STATES BANKRUPTCY COURT DISTRICT OF DEL AWA RE In re ) ) Case No. ) Debtor(s) ) Adv. Proc. No. ) ) ) MEDIATORS CERTIFICATE OF COMPLETION Plaintiff(s) ) ) v. ) ) Defendant(s) ) In accordance with this Courts Order Assigning Adversary Proceeding to Mediation, dated ___________________, the undersigned mediator reports that the mediation was completed on _______________________ and resolved in the following manner (complete applicable provisions): (a) The following individuals were present: (1) Parties (name and capacity) - (2) Counsel (name and party representing) - (b) The following parties failed to appear and/or participate as ordered: (c) The outcome of the mediation conference was: The matter has been completely resolved and counsel (or parties) have been instructed to file an appropriate stipulation and proposed order within twenty (20) days of the conference. The matter has been partially resolved and counsel (or parties) have been instructed to file an appropriate stipulation and proposed order regarding those claims or issues which have been resolved within twenty (20) days. American LegalNet, Inc. www.USCourtForms.com Page 1 of 2 >>>> 2 The following issues remain for this court to resolve: The matter has not been resolved and should proceed to trial. OTHER: Dated: _________________________________ Signature of Mediator Name of Mediator Mailing Address City, State, Zip Code Phone No. cc: Counsel of Record Pro Se Parties (9-24-04) American LegalNet, Inc. www.USCourtForms.com Page 2 of 2