Mediators Status Report
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Mediators Status Report Form. This is a Illinois form and can be use in Lake Local County.
Loading PDF...
Tags: Mediators Status Report, 171-327, Illinois Local County, Lake
IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT
LAKE COUNTY, ILLINOIS
IN RE THE MARRIAGE OF:
vs.
)
)
Petitioner, )
)
)
)
Respondent. )
Gen. No.
MEDIATOR’S STATUS REPORT
Name of Mediator:
Referring Judge:
(Check Appropriate Boxes)
I am unable to accept the court’s appointment to provide mediation services for the following reason(s):
Conflict of Interest
Full Caseload
Parties failed to meet terms of engagement
Other:
The following mediation sessions were conducted:
Date of Session
Duration of Session
Those in Attendance
Mediation was terminated without an agreement.
Additional mediation sessions are recommended.
An oral agreement was reached by the parties on some or all of the issues.
A written agreement was reached by the parties on some or all of the issues and a copy of the signed
agreement is attached to this report.
for the mediation services provided to the parties.
I charged $
My fee has been paid in full.
as of the date of
.
as of the date of
Petitioner owes a balance of $
.
and/or
Respondent owes a balance of $
I request that the court order the parties to pay their outstanding balance, or set a hearing on
the disputed amount.
Date:
Mediator
American LegalNet, Inc.
www.USCourtForms.com
Page 1 of 1
171-327 (R12-04)
