FILE NO. _______________ GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION STATE OF NORTH CAROLINA COUNTY OF ______________________ _________________________ Plaintiff VS. ORDER FOR PARTIES TO ENGAGE IN COURT-ORDERED CHILD CUSTODY MEDIATION _________________________ Defendant This District has adopted Mandatory Child Custody Mediation for all custody actions. Whether the petition is for an initial determination of custody or a motion for a change of custody or visitation, all parties must attend a Mandatory Custody Mediation session with the Custody Mediator unless they have been exempted or, by the date scheduled for Mediation, made an appointment with an alternate mediator satisfactory to all parties and approved by the Custody Mediator or the Court. Therefore, you are ordered to appear for a custody mediation session on _____________________ at ___________________________________________________ unless an exemption or alternative arrangements have been approved in writing by the Custody Mediator or by order of a judge. Should you fail to appear, you may be cited for contempt. This ___ day of ____________, 20 __. _________________________________ John W. Smith Chief District Court Judge A copy of this order was served on the following parties in the following manner: On ___________________________ q personal delivery q mailing to their address of record q mailing to counsel of record q Other: On ___________________________ q personal delivery q mailing to their address of record q mailing to counsel of record. q Other: This ___ day of ____________, 20 __. _________________________________ Custody Mediator FC Rev. 7/20/2000 American LegalNet, Inc. www.USCourtForms.com