INSTRUCTIONS FOR UTILIZING REQUEST AND ORDER FOR MEDIATION FORM (These instructions were developed by FMC to assist requestor in preparing above-referenced form and moving it through the appropriate channels in a timely manner.) It takes approximately one month to get an appointment after leaving form on 3rd floor for signature. If you have a court date within this period of time, please wait and ask for mediation in Court. Read instructions in their entirety before completing form: 1. The form must be completed in its entirety. The Plaintiff and Defendant will be the same as all your original court documents. Complete and correct addresses on both parties are mandatory. The date and signature line for the judge are the only items that need to be left blank. Once form is completed, take it to the third floor of the Family Courts. Place the form in the department's box. a. If you want to pick up the signed document, place a post-it on the form asking the department to call you. When you pick up the signed form, take it to the kiosk on the first floor where you will electronically file the document. A file-stamped copy will be emailed to you. 2. 3. Once you receive the electronic copy, bring the copy to the Family Mediation Center (FMC) and complete a data sheet so that an appointment can be set. NOTE: It is your responsibility to mail a copy (certified mail) of the filed document to the opposing party. 4. If you are unable to bring a copy to FMC, please call us at (702) 455-4186 and let us know that the document has been filed. We New RO Instruct.doc (Rev 10/19/10) American LegalNet, Inc. www.FormsWorkFlow.com can print a copy and schedule an appointment. New RO Instruct.doc (Rev 10/19/10) American LegalNet, Inc. www.FormsWorkFlow.com ORDER DISTRICT COURT FAMILY DIVISION CLARK COUNTY, NEVADA ) ) ) ) ) ) ) ) Plaintiff -vsDefendant Case No. Department FMC REQUEST AND ORDER FOR MEDIATION ­ NRS 3.475 In accordance with NRS 3.475, all individuals filing an answer to a complaint/motion for contested, child-related divorce or post-divorce child-related issues are mandated to attend mediation toward the resolution of custody/access issues. Upon the filing of this order, the plaintiff and defendant shall attend mediation through the FMC court-connected program. The Family Mediation Center will contact both parties using the information provided below. If this information is incorrect, the Court will be informed. The party completing this form must make sure the other party is served and that the Family Mediation Center has received a file-stamped copy. If either party needs an interpreter, please list language: PLAINTIFF INFORMATION: Name: Address: Home Phone: Work Phone: Best time for appt? AM PM Attorney's Name: DEFENDANT INFORMATION: Name: Address Home Phone: Work Phone: Best time for appt? AM PM Attorney's Name: Phone Number: Phone Number: CHILD(REN) INFORMATION [First & Last Name and Date of Birth (DOB)]: Name: Name: DOB: DOB: Name: Name: DOB: DOB: _________________________________________________ Signature of Individual Completing this form ____________________________________________ Attorney Signature (if Applicable) Court Use Only Ordered and dated this _____ day of ______________, 20___. District Judge (White copy ­ Court File) (01/08) (Canary copy ­ Family Mediation Center) ReqOrder (2).doc American LegalNet, Inc. www.FormsWorkFlow.com