Limited Appointed Of Counsel Pursuant To The Pro Se Mediation Program Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Limited Appointed Of Counsel Pursuant To The Pro Se Mediation Program Form. This is a Massachusetts form and can be use in District Court Federal.
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Tags: Limited Appointed Of Counsel Pursuant To The Pro Se Mediation Program, Massachusetts Federal, District Court
UNITED STATES DISTRICT COURT
DISTRICT OF MASSACHUSETTS
_______________________________
Plaintiff
v.
Civil Action Number __________________
_______________________________
Defendant
LIMITED APPOINTMENT OF COUNSEL
PURSUANT TO THE PRO SE MEDIATION PROGRAM
The Court hereby appoints the herein named attorney to represent the pro se party solely for
the limited purpose of assisting the pro se party in connection with mediation proceedings in this
case. Appointed counsel shall not be obligated to conduct any discovery, to prepare or respond to
any motions and shall not be responsible for the trial of this case. On notice to the Court, appointed
counsel may seek to end the representation of the pro se party upon completion of the mediation
proceedings.
Name of Appointed Counsel:
________________________________________________
Law Firm:
________________________________________________
Street Address:
________________________________________________
Suite Number:
________________________________________________
City, State & Zip Code:
________________________________________________
Telephone Number:
________________________________________________
I hereby acknowledge that I have read, understand and agree to the terms of this Limited
Appointment of Counsel Pursuant to the Pro Se Mediation Program.
________________________
Date
________________________________________________
Pro se party
________________________
Date
________________________________________________
Counsel