STATE OF NORTH CAROLINA COUNTY OF MECKLENBURG IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION CASE NUMBER _____________________ ________________________________ ________________________________ PLAINTIFF VS. ________________________________ MOTION FOR WAIVER OF PARENT EDUCATION AND/OR CUSTODY MEDIATION ________________________________ DEFENDANT …………………………………………………………………………….………………………………… The undersigned requests a waiver of Parent Education and/or captioned case based upon the following: _____ _____ _____ _____ _____ _____ _____ _____ Custody Mediation in the above- The party has completed a comparable Parent Education course and filed a certificate of completion with the court Undue hardship The parties have agreed to voluntary mediation There are allegations of abuse or neglect of the minor child * There are allegations of alcoholism, drug abuse, or domestic abuse There are allegations of severe psychological, psychiatric, or emotional problems The party resides more than fifty miles from the court Other good cause The facts upon which this request for waiver is based are: ____________________________________________________________________________________ ____________________________________________________________________________________ The undersigned requests does not request an evidentiary hearing on the motion. This the ______ day of ______________________________ , 20____. ____________________________________________ __ Plaintiff __ Attorney for Plaintiff __ Defendant __ Attorney for Defendant Note to Opposing Party: You have seven days from receiving this motion to file any response. Served on: ______________________________ Plaintiff or Plaintiff's Attorney ______________________ Date ______________________________ Defendant or Defendant's Attorney ______________________ Date ______________________________ Custody Services Case Manager ______________________ Date ____________________ Domestic abuse refers to acts of intimidation, harassment, coercion or violence perpetrated by an intimate partner against a current or former intimate partner. Nonphysical acts of domestic abuse include but are not limited to emotional abuse, isolation, threats, and the use of gender privilege. Physical acts include but are not limited to pushing, shoving, choking, slapping, hitting, using weapons, and physically detaining. These acts serve to maintain the abuser's power and control over the abused person. CCF-55 6/5/00 American LegalNet, Inc. www.USCourtForms.com Certificate of Service I certify that I served the above Notice by: delivering a copy personally to: Name of Person(s) and Place Served: Name of Person(s) and Place Served: Also served on: Custody Services Case Manager 800 East Fourth Street, Suite 211 Charlotte, NC 28202 depositing a copy in the United States mail in an envelope bearing proper postage and addressed as follows: Name and Address Name and Address Also served on: Custody Services Case Manager 800 East Fourth Street , Suite 211 Charlotte, NC 28202 leaving a copy at the office of the attorney named below, with a partner or employee: Name Of Attorney Name Of Attorney Party Represented Party Represented Person With Whom Copies Left Person With Whom Copies Left Also served on: Custody Services Case Manager 800 East Fourth Street, Suite 211 Charlotte, NC 28202 Date of Service Signature of Person Serving Notice Name, Address, and Telephone Number CCF-55 6/5/00 American LegalNet, Inc. www.USCourtForms.com