FOC REQUEST FOR CONCILIATION SERVICES Please print. If not legible, conciliation will not be scheduled. Case Number: 09- Date: Name of Judge: Name of Mother: Complete Address: Telephone Number: Mother222s Attorney: ************************************************************ Name of Father: Complete Address: Telephone Number: Father222s Attorney: Has a motion for a temporary order already been filed with the Court? Y / N Do you have an active financial responsibility (child support) case involving the other parent? Y / N I request FOC assistance. SIGNED: Printed name: Return form to: ADR Unit Friend of the Court Office 82 Ionia, Suite 200 PO Box 350 Grand Rapids, MI 49501-0351 OFFICE USE ONLY DATE RCVD FOC: DATE OF APPT: TIME OF APPT: OUTCOME: FTA: MEDIATION NEEDED: Y / N REFERRED FOR EVAL: Y / N OPT OUT: Y / N CANCELLED BY: NOT SCHEDULED: ACTIVE CASE: T.O. / MOTION FILED: American LegalNet, Inc. www.FormsWorkFlow.com