File No. STATE OF NORTH CAROLINA COUNTY OF CUMBERLAND IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION Name Plaintiff MOTION TO EXEMPT CHILD CUSTODY/VISITATION MEDIATION Cumberland County Child Custody/Visitation Mediation Rule 6 vs. Name Defendant Name of Domestic Case Manager Date of Mediation Hearing MOTION TO EXEMPT CHILD CUSTODY/VISITATION MEDIATION The undersigned attorney/ party requests exemption of Child Custody/Visitation Mediation based upon the following reason(s): NOTE: Indicate with particularity the reason for request. _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _____________________________________________ THIS MOTION IS TO BE FILED WITH THE FAMILY COURT ADMINISTRATORS OFFICE. Date Signature of Attorney/Party Address and Telephone Number p Attorney for Plaintiff/ Pro Se p Attorney for Defendant/ProSe CERTIFICATION NOTE: Complete this section if the reason stated above requests an exemption due to travel in excess of fifty miles.I hereby certify that my physical place of residence is located in excess of fifty miles from the Cumberland County Courthouse. Name of Party Traveling in Excess of Fifty Miles Physical Address of Party (Include Street/City/ State)Approximate Number of Miles ORDER The court having considered the request for exemption from Child Custody/ Visitation Mediation based upon the foregoing reasons orders that this case is: p Exempt from Child Custody/Visitation Mediation. p NOT Exempt from Child Custody/Visitation Mediation. NOTICE: Exemption of Child Custody/Visitation Mediation does not exempt one or more parties from participating inthe Parenting Education Sessions. Parties receiving an exemption due to the 50 mile plus rule must contact the Family Court Administrator for referral to an approved parenting education program. Date Signature of the District Court Judge CCLF-FC-010 (Rev. 11/00)