STATE OF NORTH CAROLINA Harnett County Name of Plaintiff File No. In The General Court Of Justice District Court Division VERSUS Name of Defendant MOTION AND ORDER TO RETURN TO CUSTODY MEDIATION G.S. 50-13.1 Date(s) of Order(s) Modifying Original Order Date of Original Custody Order MOTION The parties move that this case be referred to the Custody Mediation Program for mediation of certain unresolved custody and visitation issues in this case, and in support of the motion state: 1. The custody order which was originally entered on the date shown above and modified on the subsequent dates(s) shown above is currently in effect in this case. 2. Custody/visitation issues have arisen under the order. 3. The parties wish to resolve these issues without formal court proceedings and have consented to return to mediation to attempt to do so. Date Date Signature Plaintiff Plaintiff's Attorney Signature Defendant Defendant's Attorney Address Address ORDER The above Motion is allowed and it is ORDERED that this case be referred to the Custody Mediation Program for mediation of all unresolved custody and visitation issues in this case. The above Motion is denied. Date Signature of Judge Name of Judge (Type or Print) DOM-13 (10/2014) District 11 ­ Custody Mediation American LegalNet, Inc. www.FormsWorkFlow.com