NORTH CAROLINA COUNTY OF WAKE IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION FILE NO. ____________________________ Assigned Judge:_______________________ ___________________________________, Plaintiff, v. ___________________________________, Defendant. PARENTING COORDINATOR’S NOTICE OF DETERMINATION THAT REQUIRES A COURT HEARING (N.C.G.S. § 50-97) NOW COMES THE UNDERSIGNED Parenting Coordinator, _________________________ , in accordance with N.C. Gen. Stat. 50-97 to provide to the Court written notification that the Parenting Coordinator has made a determination requiring a prompt review. As more fully explained in the attached Parenting Coordinator report, the Parenting Coordinator has determined that: The existing custody order is not in the best interests of the child; The parenting coordinator is not qualified to address or resolve certain issues in the case, specifically: The undersigned hereby certifies that he/she is the Parenting Coordinator in the above-entitled action; that the attached report is a true and correct copy of the report prepared by this Parenting Coordinator and was 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; that he/she has prepared the foregoing document and attachments and knows the contents therein, and that the same is true to his/her own knowledge, save and except for those matters and things stated herein upon information and belief, and as to such matters and things, he/she believes them to be true. This the _____ day of __________________________, 20_______. ___________________________________________ Parenting Coordinator STATE OF NORTH CAROLINA COUNTY OF _______________ Sworn and subscribed personally before me, this the ______ day of __________________ 20______. __________________________________________________ Notary Public My Commission Expires: _____________________________ WAKE-DOM-26 Page 1 of 2 (Rev. 02/10) American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF SERVICE I hereby certify that a copy of this Parenting Coordinator’s Notice of Determination that Requires a Court hearing has been served on the parties/parties’ counsel and the assigned Family Court Case Coordinator in the following manner: By depositing a copy in the US Mail in a properly addressed, postpaid envelope to: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ By hand delivery to: ___________________________________________________________ ____________________________________________________________________________ By facsimile to: ______________________________ Fax No.: _______________________ Other: ______________________________________________________________________ ____________________________________________________________________________ Date: _____________ ________________________________________________________ Parenting Coordinator WAKE-DOM-26 Page 2 of 2 (Rev. 02/10) American LegalNet, Inc. www.FormsWorkFlow.com