STATE OF MAINE DISTRICT COURT Location Docket No. Plaintiff CERTIFICATE IN LIEU OF CASE MANAGEMENT CONFERENCE v. Defendant 1. AGREEMENT OF THE PARTIES. (Please check the appropriate box.) A. FULL FINAL AGREEMENT. We, the parties in this family matter case, certify that we have reached a full final agreement on all issues. B. TEMPORARY AGREEMENT. We, the parties in this family matter case, certify that we have reached a temporary agreement on all issues relating to the children. C. This is a post-judgment action, and a court order is in effect. We wish to proceed directly to mediation. Mediation fee is enclosed. 2. DOCUMENTS ATTACHED. The following documents are attached: A. (Check the appropriate box.) A full settlement agreement resolving all issues; OR A temporary written agreement on parental rights and responsibilities that explains with whom the child(ren) will be residing, what the schedule for parent-child contact will be, and how the child(ren) will be financially supported. B. A completed Child Support Affidavit for each parent, if one has not previously been filed with the court. C. A completed Child Support Worksheet. If a temporary order is requested, a proposed Child Support Order and Immediate Income Withholding Order must also be attached. (These forms are available at the court clerk’s office.) 3. OTHER ORDERS REGARDING CUSTODY OR SUPPORT. (Check the appropriate box.) A. There are no other orders regarding custody or support of the child(ren). B. There is another order regarding custody or support, but our temporary agreement is the same as that order. C. There is an existing custody or support order that is different from our temporary agreement. A copy is attached. 4. DOMESTIC VIOLENCE OR ABUSE HISTORY. We certify that the following information is correct: A. Protection from Abuse Order(s) affecting the parties or their children. None Prior Order(s) no longer in effect Order(s) currently in effect [Name and Location of all Courts, Docket Numbers & Dates of all current and prior Orders] B. Criminal case(s) affecting contact between the parties or between a party and the child(ren). None Pending case(s) Completed case(s) [Name and Location of all Courts and Docket Numbers of all Cases] FM-054, Rev.09/05 American LegalNet, Inc. www.USCourtForms.com 5. CONTESTED ISSUES. The following issues are unresolved but do not require the court’s attention at this time, because all interim issues have been resolved the contested interim issues are unrelated to the children: Parental Rights & Responsibilities Actual or Imputed Income of party Marital vs. Non-marital property Guardian Ad Litem Fees Other: Primary Residence Spousal Support Pensions or Benefits Paternity Rights of Contact Real Estate Allocation of Debt Medical Insurance Child Support Support Arrearage Personal Property Attorney’s Fees 6. NEXT COURT DATE. [Choose one of the following.] The Clerk shall schedule the following court date: An uncontested final hearing will be held on A pretrial or status conference will be held on Mediation will be held on (If mediation is requested, the mediation fee must accompany this certificate.) at at at a.m./p.m. a.m./p.m. a.m./p.m. If the next court event is a pretrial or status conference, we understand the following deadlines apply: (1) any required Financial Statement must be filed within 30 days, (2) the deadline for discovery is 60 days, and (3) any required mediation must be held within 90 days. If the next court event is an uncontested final divorce hearing, we understand we must file a completed Certificate Regarding Real Estate prior to the hearing if one or both of us has an interest in any real estate. (This form is available at the court clerk’s office.) 7. CERTIFICATION. By signing this agreement, we certify that all issues affecting our child(ren) have been temporarily resolved. We ask the Court to: adopt our agreement as an interim order of the court and waive the case management conference; OR review our agreement and waive the case management conference. We understand either party may request a case management conference if the agreement is not being followed. We understand that the Court will review our agreement and may require us to attend a case management conference even though we have filed this certificate. Date: Plaintiff or Plaintiff’s Attorney Date: Defendant or Defendant’s Attorney ORDER The agreement of the parties, which is set forth in the attached Child Support Order, Immediate Income Withholding Order and written agreement on parental rights and responsibilities, is approved as an interim order of the court, and the Case Management Conference is waived. The agreement of the parties has been reviewed and the Case Management Conference is waived. The agreement of the parties has been reviewed and the Case Management Conference is not waived because . The conference is scheduled for at a.m./p.m. Date: Magistrate/Judge American LegalNet, Inc. www.USCourtForms.com