File No. STATE OF NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE COUNTY OF ____________________ SUPERIOR COURT DIVISION Name Plaintiff _____________________________________ MOTION TO DISPENSE WITH Vs MEDIATED SETTLEMENT Name Defendant CONFERENCE _____________________________________ NOTICE TO THE TRIAL COURT COORDINATOR The undersigned party request this case be exempt from the Mediated Sett lement Conference. This request is based upon the following reason(s): Trial Date Note: Indicate with particularity the reason for request All opposing counsel/party(ies) consent to the motion. Date Name of Movant Address and Telephone Number Attorney for Plaintiff Attorney for Defendant Unrepresented Party Copy of this Notice distributed to: Indicate method of service to opposing parties (Provide Name and Address of all parties) US Mail Facsimile Hand Delivery Notice: All counsel/parties have a continuing obligation to notify this office of any correction/addition/deletion of counsel. Objection(s) received PART B (For Official Use Only) no yes (attach written objections) DO NOT WRITE IN THIS SPACE Date Motion Received Ruling Denied Granted Date Trial Court Coordinator American LegalNet, Inc. www.USCourtForms.com