Original - Court 2nd copy - Defendant Approved, SCAO 1st copy - Plaintiff 3rd copy - Mediator STATE OF MICHIGAN CASE NO. JUDICIAL DISTRICT NOTICE REGARDING JUDICIAL CIRCUIT COURT SELECTED MEDIATOR COUNTY PROBATE Court address Court telephone no.Plaintiff name(s), address(es), and telephone no(s). Defendant name(s), address(es), and telephone no(s). v Plaintiff attorney, bar no., address, and telephone no. Defendant attorney, bar no., address, and telephone no. Probate In the matter of TAKE NOTICE: 1. This case was ordered to mediation on . Date 2. The time has passed for the parties to select their own mediator. 3. The court has selected as the mediator according to Name of mediator its alternative dispute resolution plan and has notified the mediator of his/her obligations under the court rules. Date Signature MC 275 (8/00) NOTICE REGARDING COURT SELECTED MEDIATOR MCR 2.411(B)