FORM #6 United States Bankruptcy Court Western District of Michigan {INSERT BANKRUPTCY CASE/ADVERSARY PROCEEDING CAPTION} NOTICE OF CASE EVALUATION AWARD WITH ACCEPTANCE OR REJECTION 1. The following parties participated in the Case Evaluation session held on the date signed, below. ______________________________________________ on behalf of ______________________________________________ ______________________________________________ on behalf of ______________________________________________ ______________________________________________ on behalf of ______________________________________________ ______________________________________________ on behalf of ______________________________________________ ______________________________________________ on behalf of ______________________________________________ ______________________________________________ on behalf of ______________________________________________ 2. The Case Evaluation Panel evaluates this dispute as follows: {Type or write the award in the space below.} 3. 4. The undersigned certify a copy of this award was personally served on all parties or via First Class Mail. This award: was was not unanimous. ________________________________________________________ Case Evaluator _________________________________ Date _________________________________ Date ________________________________________________________ Case Evaluator _________________________________ Date ________________________________________________________ Case Evaluator ACCEPTANCE/REJECTION OF AWARD (Parties must complete the following and file this form with the ADR Administrator within 14 days after service of this notice or the evaluation will be considered rejected. If the panel's evaluation is rejected by either party, and this matter proceeds to trial, actual costs may be assessed in accordance with LBR 9019-22(e).) (Check one) I hereby: a. accept this evaluation award. b. reject this evaluation award. c. accept this evaluation award only if: i. all opposing parties accept. ii. the opposing parties accept as to the following specified co-parties: _________________ Date _____________________________________ Attorney/Party signature _____________________________________ Attorney/Party name (type or print) American LegalNet, Inc. www.FormsWorkFlow.com