COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar No. ALTERNATIVE DISPUTE RESOLUTION REPORT : Plaintiff(s) FAMILY LAW (FORM 68-2) JUDICIAL SUBPOENA -against- : : : In Re: ____________________________ Case Number: ______________________ Defendant(s) : ...................................................... Family Court Judge: _______________________________ Case Referred for Mediation, Date: ___________________ THE PEOPLE OF THE STATE OF NEW YORK Mediator Assigned/Chosen: _________________________ Date: ____________ TO GREETINGS: REPORT OF THE MEDIATOR WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Date of Mediation Session: _____________________ Number of hours: ____________ , the Honorable at the Court located at CountyOne or More) of (Check in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date,appeared for initial mediation session. action on the part of the to testify and give evidence as a witness in this ___ Both parties ___ One or both parties failed to appear for initial mediation session. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to ___ Parties reached a tentative resolution of issues. the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. ___ No further mediation scheduled or would be beneficial. Witness, Honorable , one of the Justices of the ___ By in the parties,day of mediation ,session scheduled for: next Court agreement ofCounty, 20 ____________________. ___ Other, explain: (Attorney must sign above and type name below) _______________________________________________________________________ _______________________________________________________________________ Attorney(s) for Signature: ___________________________________ Date: _____________________ Office and P.O. Address (Mediator) Signature: ____________________________ Signature: ________________________ (Party 1) (Party Telephone No.: 2) Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com