IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY, ILLINOIS _______________________________________ CASE NO. _________________________________ MEDIATOR NAME ___________________________ ADDRESS _______________________________________ ______________________________________________________ Plaintiff vs _______________________________________ Defendant PHONE # ____________________________________ E-MAIL _____________________________________ ORDER FOR MEDIATION Check box if present: Plaintiff's Attorney Defendant's Attorney This cause coming on for ____________________________, and the court being advised in the premise. FINDS: 1. That a dispute exists between the parties involving allocation of significant decision-making responsibilities parenting time other parenting issues: ______________________________ _______________________________________________________________________________. The parties shall each contact the mediator on or before ________________________, 20_____ to schedule an appointment to begin mediation. The initial payment for three (3) hours of mediation services shall be allocated as follows: _______________________________________________________________________________. Further payments shall be allocated as follows: _________________________________________. This cause is continued to ________________________, 20_____ at 9:00 a.m. for status on mediation and mediator's report. __________________________________ shall forthwith send a copy of this order to the mediator, both parties, and the Office of the Court Administrator, 57 N. Ottawa Street, Joliet, 3rd floor, Joliet, Illinois 60432; fax (815)774-4576. The mediation ordered herein is subject to the Local Rules of the Twelfth Judicial Circuit. Dated: __________________________, 20_______ Enter: ____________________________________ Judge Plaintiff's Attorney: Defendant's Attorney: Name _____________________________________ Name _____________________________________ ARDC # ___________________________________ ARDC # ___________________________________ Firm Name _________________________________ Firm Name _________________________________ Address ___________________________________ Address ___________________________________ City & Zip _________________________________ City & Zip _________________________________ Telephone _________________________________ Telephone _________________________________ Fax/Email _________________________________ Fax/Email _________________________________ ANDREA LYNN CHASTEEN, CLERK OF THE CIRCUIT COURT OF WILL COUNTY Orig. ­ Court Copy ­ Plaintiff Copy­ Defendant American LegalNet, Inc. www.FormsWorkFlow.com 2. 3. 4. 5. 6. 7. CO 12 Revised (12/16)