STATE OF ILLINOIS ) )SS COUNTY OF WILL ) IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY, ILLINOIS _______________________________________ Plaintiff vs CASE NO: ______________________________ _______________________________________ Defendant CIVIL LAW: (INTERIM) (FINAL) MEDIATION REPORT The mediation took place on the following dates: _________________________________________________ for a cumulative total of __________ hours. I have been paid the sum of $________.00 for my services billed at the rate of $________ per hour. ‰ The parties have reached an agreement as to all disputed issues per the Mediation Order (full agreement). ‰ The parties have reached an agreement as to certain issues but there remain other issues that were not resolved through mediation (partial agreement). . ‰ Mediation has failed to result in any agreement (no agreement). ‰ Other (please indicate) _______________________________________________________________ _______________________________________________________________________________________. . I recommend that additional mediation sessions be scheduled because there is a reasonable likelihood that they will result in agreement concerning the following issues: _________________________________________________________________________________________ _________________________________________________________________________________________. Dated: ____________________________, 20 ______ Signed: _____________________________________ (Mediator) Address: _________________________________ _________________________________________ Telephone: ________________________________ Fax: _____________________________________ PAMELA J. MCGUIRE, CLERK OF THE CIRCUIT COURT OF WILL COUNTY White – Court Yellow – Plaintiff Pink – Defendant American LegalNet, Inc. www.FormsWorkFlow.com CO 21 (Revised 12/09)