UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NORTH CAROLINA ____________ DIVISION Case No. __________________________ Name of Plaintiff(s): REPORT _________________________________________ VERSUS Name of Defendant(s): OF _________________________________________ Mediator Name: MEDIATOR ___________________________________________ _________________________________________________ 9 This is an Interim Report. A final report is to be filed after resumption of the mediation. Telephone No.: _________________________________________ 1. Convening of Mediation. The mediated settlement conference ordered in this case: 9 was held on ________________________________(date) 9 was NOT held because: __________________________________________________________. 2. Attendance. 9 No objection was made on the grounds that any required attendee was absent. 3. Outcome. The mediation resulted in: 9 complete settlement of the case 9 partial settlement of the case 9 recess (i.e., mediation to be resumed at later date) 9 impasse 9 other disposition. Specify: _________________________________________________________. 4. Settlement Filings. (a) The document (s) to be filed to effect the settlement are: ________________________ ___________________________________________________________________________________________ (b) The person responsible for filing the documents is:________________________________________________ (c) The agreed deadline for filing the document(s) is: _________________________________________________ 5. Submission of Report. Please submit the completed and signed report by mail to Clerk of Court, POB 25670, Raleigh, NC 27611. I have submitted this completed report within seven (7) days after conclusion of the conference. Signature of Mediator: Date: __________________________________________________ _____________________________________________ FOR COURT USE 9 Consent Judgment 9 Voluntary Dismissal with Prejudice 9 Voluntary Dismissal without Prejudice Date: Filed By: American LegalNet, Inc. www.FormsWorkFlow.com