COURT Mediation COUNTY .OF. . . . . . . . . . . . . . . . . . .Form .C .- .Custody . . . . . . . . ......... .. .... . ....... : In The General Court Of Justice Index No. STATE OF NORTH CAROLINA District Court Division Wayne County : Family Calendar No.Court : JUDICIAL SUBPOENA File No. Plaintiff(s) Plaintiff: -against- : VERSUS Defendant: : MOTION TO WAVIE CUSTODY MEDIATION NOW COMES the undersigned party and moves the Court to waive the Custody:Mediation process for the following reason(s): False allegations or untrue statements submitted in this motion may result in the Moving Party being subject to : Contempt or .sanctions .by. this. Court. . . . . . . . . . . . .Defendant(s) . . . . . . . .... ........ . ... ..... .......... 1 Custody Mediation would cause an Undue hardship on me: (Explain) 2 THEparties have reached an agreementNEW YORK The PEOPLE OF THE STATE OF for voluntary mediation. Mediator's Name: Date: Time: Place: TO 3 There are allegations of abuse or neglect of the minor child or children. (Explain) GREETINGS: 4 There are allegations of alcoholism, drug abuse, or spouse abuse. (Explain) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court 5 County ofallegations of psychological, psychiatric, or emotional problems. (Explain) There are located at in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the 6 I live more than fifty (50) miles from the Court. My residence is located in (name of city and state) Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result party has ten (10) days The opposing of your failure to comply.from receipt of this Motion to object, in writing, to the waiver of medation. (Note: Many parents have chosen to take advantage of Custody Mediation even when they lie more than fifty (50) miles from the Court.) NOTICE , Case Manager and of been I hereby certify that aWitness, Honorable Waive Custody Mediation has been submitted to the one of the Justiceshas the served on copy of this Motion to the other party inin following manner: Court the County, day of , 20 By depositing a copy in the United States mail in a properly addressed, postpaid envelope to: (Attorney must sign above and type name below) Attorney(s) for By Hand delivery By Sheriff's service Date Moving Party Office and P.O. Address Eighth Judicial District Form C - Custody Mediation 3/01 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com