Domestic Violence Screening For Referral To Mediation
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Domestic Violence Screening For Referral To Mediation Form. This is a Michigan form and can be use in Alternative Dispute Resolution Statewide.
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Tags: Domestic Violence Screening For Referral To Mediation, MC 282, Michigan Statewide, Alternative Dispute Resolution
Approved, SCAO
STATE OF MICHIGAN
JUDICIAL DISTRICT
JUDICIAL CIRCUIT
COUNTY PROBATE
CASE NO.
DOMESTIC VIOLENCE SCREENING
FOR REFERRAL TO MEDIATION
Court address
Court telephone no.
Plaintiff's name
Defendant's name
v
Plaintiff's attorney, bar no., address, and telephone no.
Defendant's attorney, bar no., address, and telephone no.
Note: If you have an attorney, this form should be completed with your attorney.
Please return this completed form to the ADR clerk at the above court address within 7 business days.
Instructions: If there are any actions involving you or the other party, specify the names of the persons involved, the case number,
the name of the court where the action was filed, including the county and state. If there are no actions, write "NONE."
1. I am aware of the following personal protection actions involving myself and/or the other party:
2. I am aware of the following domestic violence criminal actions involving myself and/or the other party:
3. I am aware of the following pending child protective (abuse/neglect) actions involving myself and/or the other party:
Date
MC 282 (3/08)
Signature
DOMESTIC VIOLENCE SCREENING FOR REFERRAL TO MEDIATION
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