State of North Carolina General Court of Justice District Court Division Fifth Judicial District New Hanover County Judicial Building 316 Princess Street Suite 519 Wilmington, N.C. 28401-4099 John W. Smith Phone: (910) 341-4416 Chief District Court Judge Fax: 910-341-4071 File No. _________________________ NOTICE TO PARTIES FOLLOWING MEDIATION: Thank you for participating in the Fifty Districts Child Custody Med iation program. You have discussed the possibility of settlement of the issues of custody and visitation, and the terms upon which general agreement has been reached are set out in the attached memorandum. Now that the terms have been reduced to writing, you have several options. This letter is to provide you with sufficient informat ion so that an informed decision can be made as to what should be done next. IF YOU ARE REPRESENTED BY AN ATTORNEY, you should take the attached memo randum together with this letter to your attorney and discuss this matter with your attorney. The attorney will advise you as to what you should do next. IF YOU ARE NOT REPRESENTED BY AN ATTORNEY, you have an absolute right to contact an attorney of your choice to discuss the issue of child custody and visitation. If yo u choose to represent yourself, you will need to read and sign the following acknowledgement to insure that you are makin g this decision with adequate information: I have chosen to represent myself. I understand that I have an absolute right to contact an attorney about the issue of child custody and visitation. I also understand that there is a child support law and that any agreement concerning custody may affect my child support obligations. I also understand that if this agreement provides that it is to be converted into a court order, that i t may have the same enforceability as any other court order, and that I may be held in contempt if I violate i t. I have made the decision to represent myself freely and voluntarily and I believe that I fully under stand what I am dong. I have read the memorandum, and I understand its contents. I want to enter this consent agr eement and I do not wish to talk further with any attorney. I understand that if both parties do not sign an agreement, my signing this document will not be used against me in any way. Date:______________________ Signature:____________________________________ Print name:___________________________________ For successful mediation to occur, an agreement needs to be signed by bo th parties within a reasonable time. The Custody Mediator has made an appointment for you on __________________, and you will need to return on that date with a decision whether to enter this agreement or not. If you cho ose not to enter the agreement, unless the time is extended by the Custody Mediator, the court will be notified that attempts to mediate have not been successful, and that the matter should be returned to the trial calendar . Thank you for giving mediation a chance, and regardless of the outcome w e appreciate your participation in this pre-trial effort to resolve this very difficult issue. Very truly yours, I received a copy of this notice on ________________ _______________________________________ John W. Smith Chief District Court Judge _______________________________________ FC Rev. 7/20/2000 American LegalNet, Inc. www.USCourtForms.com