NORTH CAROLINA GUILFORD COUNTY _______________________________ Plaintiff v. _______________________________ Defendant IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION File No. ______________ CONSENT STIPULATION OF MEDIATOR (FAMILY FINANCIAL CASE) COMES NOW, the undersigned attorneys, or parties (if pro se) in this action, and do hereby stipulate and agree that the following mediator shall serve as the mediator in this family financial action: NAME: ADDRESS PHONE NUMBER FAX NUMBER ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ Non-Certified Family Financial Mediator Certified Family Financial Mediator The undersigned additionally hereby certify that the mediator named above has agreed to serve as mediator in this action and that a copy of this Stipulation has been served on the aforementioned mediator in accordance with Rule 5 of the North Carolina Rules of Civil Procedure. SIGNATURE NAME DATE ADDRESS PHONE NO. EMAIL ____________________________ ____________________________ Attorney for Plaintiff Plaintiff ____________________________ ____________________________ ____________________________ ____________________________ SIGNATURE NAME DATE ADDRESS PHONE NO. EMAIL ____________________________ ____________________________ Attorney for Defendant Defendant ____________________________ ____________________________ ____________________________ ____________________________ Note to Mediator: The mediator shall be responsible for reserving a place and making arrangements for the conference and giving timely notice to all attorneys and unrepresented parties of the time and location of the conference. The mediated settlement conference shall be completed by the completion deadline set forth in the Standing Order or in another Order entered by the presiding Judge and the mediator shall report the results of the conference to the Court within ten (10) days after the conference is completed or within ten (10) days of being advised by a party that the case settled or was otherwise disposed of prior to mediation. CMR-240 Rev. 12/2013 American LegalNet, Inc. www.FormsWorkFlow.com