Original - Court 2nd copy - Defendant Approved, SCAO 1st copy - Plaintiff 3rd copy - Mediator STATE OF MICHIGAN CASE NO. JUDICIAL DISTRICT STIPULATION FOR MEDIATION JUDICIAL CIRCUIT 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 1. The parties agree that this matter shall be submitted to mediation under MCR 2.411(B). mediation under MCR 3.216(A)(1). evaluative mediation under MCR 3.216(A)(2). 2. At the request of the parties, has agreed to serve as mediator. Name Date Plaintiff/Attorney signature Date Defendant/Attorney signature USE NOTES: Item 2 must be checked in general civil matters if parties stipulate to mediation. If item 2 is not completed in a domestic relations matter and evaluative mediation is not requested, mediation will be nonevaluative and a mediator will be assigned from the court roster of domestic relations mediators. After this form is filed with the court, an order for mediation will be prepared for the judges signature. MC 279 (8/00) STIPULATION FOR MEDIATION MCR 2.411(B), MCR 3.216(A)