FAM106 State ENG Rev 7/15www.mncourts.gov/formsPage 1 of 2State of Minnesota District Court County of: Select County Judicial District: Court File Number: Case Type: Name of Petitioner (first, middle, last)and Name of Respondent (first, middle, last) In Re the Marriage of: In Re the Custody of: IntervenorCertificate of Settlement Efforts (Minn. Gen. R. Prac. 303.03(c)) I am the party or the attorney who filed a motion in this case. I understand that I am required by Rule 303.03(c) to contact the other party within 7 days of filing my motion to attempt a settlement of the issues and to discuss what type of Alternative Dispute Resolution (ADR) is appropriate in this case. I understand that as the moving party, I must certify to the court that I have complied with Rule 303.03(c), or on what basis I am not required to comply with Rule 303.03(c). I understand that I am required to file this Certificate of Settlement Efforts with the court at least twenty-four (24) hours before the hearing on my motion, and that the court may remove the hearing from the calendar if I fail to comply with Rule 303.03(c). Check all that apply: Within days of filing my motion, I contacted the other party, or other party'sattorney to try to settle or reach an agreement on the issues in my motion. The other party or attorney refused to talk with me or did not respond to my calls, emails,texts, letters, etc.. We discussed the following type of ADR in an effort to settle the issues: (state it here) The parties are exempt from settlement efforts because: There is no court determination of the parent and child relationship in a parentage case. This case is a domestic abuse action under Chapter 518B. This case is a contempt action American LegalNet, Inc. www.FormsWorkFlow.com FAM106 State ENG Rev 7/15www.mncourts.gov/formsPage 2 of 2 This action includes maintenance, support, or parentage and the public authorityresponsible for child support enforcement is a party or is providing child support enforcement services. One of the parties claims to be the victim of domestic violence by the other party,or there is probable cause for the court to find that one of the parties or child of the parties has been physically abused or threatened with physical abuse by the other party. There is a court order in this case requiring the parties to use mediation to resolvedisputes before filing a motion. I tried to mediate before filing my motion and (check one): Mediation did not resolve all the issues; or The other party did not respond to the request to mediate or refused to mediate; or Mediation was scheduled and the other party did not appear at the mediation. I have other good reasons for not having settlement discussions with the other party. Explain Dated: Signature Name: Address: City/State/Zip: Telephone: E-mail address: County and State where signed American LegalNet, Inc. www.FormsWorkFlow.com