STATE OF NORTH CAROLINA COUNTY OF WAKE IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION FILE NO. ___________________ ____________________, Plaintiff, v. ____________________, Defendant. Assigned Judge: ___________________________ PARENTING COORDINATOR’S MOTION FOR REVIEW OF PARENTING COORDINATOR’S REPORT/CUSTODY ORDER NOW COMES THE UNDERSIGNED Parenting Coordinator and moves this Court for a review and hearing on the issue or issues raised in the attached Parenting Coordinator report pursuant to N.C. Gen. Stat. 50-97 and hereby certifying that the attached report is a true and correct copy of the report of this Parenting Coordinator and having been prepared using the notes and records kept in the normal course of business of meeting with parties and children in the undersigned role as Parenting Coordinator. This the ______ of _________________________ , 20___ . ____________________________________ Parenting Coordinator Address: Phone Number: VERIFICATION _________________________________________ , first being duly sworn, deposes and says that she is the Parenting Coordinator in the above-entitled action; that she has prepared the attached report, and knows the contents therein, and that the same is true to her own knowledge, save and except for those matters and things stated herein upon information and belief, and as to such matters and things, she believes them to be true. ______________________________ Parenting Coordinator Sworn to and subscribed before me this the ______ day of_______________________ , 20 _____. ________________________ NOTARY PUBLIC My Commission Expires: ___________________ WAKE-DOM-26 (2/06) (PAGE 1 OF 2) American LegalNet, Inc. www.USCourtForms.com CERTIFICATE OF SERVICE This is to certify that I have this day served an original and one copy of the foregoing PARENTING COORDINATOR’S MOTION FOR REVIEW OF PARENTING COORDINATOR’S REPORT/CUSTODY ORDER to the parties and court herein by: [ ] Personal delivery [ ] Confirmed Facsimile transmission [ ] Mailing a copy thereof, postage prepaid and properly addressed, to: This the _____ day of _______________________ , 20___ . ___________________________________________ Parenting Coordinator Address: Phone Number: WAKE-DOM-26 (2/06) (PAGE 2 OF 2) American LegalNet, Inc. www.USCourtForms.com