Office of Dispute Resolution SEVENTH JUDICIAL ADMINISTRATIVE DISTRICT P.O. BOX 963 CARTERSVILLE, GA 30120 www.7jad.com PHONE: (770) 387-4820 TOLL FREE: (877) 655-6865 FAX: (770) 387-5479 Attorney Referral Form Date: ____________________ Case Number: _________-CV- ____________________ County: _________________________ _________________________________v. __________________________________ ATTN: ADR Office Please note that the above-referenced case has not been referred to mediation by the Seventh Judicial Administrative District ADR Office. We feel that this case is appropriate for mediation. The information your office needs to make the final determination is listed below: 1. 2. 3. The defendant(s) resides in the state of Georgia The defendant(s) have been served What type of case is this? General Civil YES YES NO NO __________ Service Date Required ______________________ Description Description Domestic Relations ______________________ __________ Answer Date 4. 5. 6. Is there any violence alleged in this case? If yes, has a TPO been filed? PLAINTIFF'S DATA YES YES DEFENDANT'S DATA Name: (Last, First MI) Mail Address City, State and Zip Phone Attorney's Name City, State and Zip NO NO Name: (Last, First MI) Mail Address City, State and Zip Phone Attorney's Name City, State and Zip Phone Email / Fax Phone Email / Fax ____________________________________________ ____________________________________________ Signature (Required) __________________________ Name (Printed) __________________________________ American LegalNet, Inc. www.FormsWorkFlow.com