STATE OF NORTH CAROLINA County Name And Address Of Party Requesting Prelitigation Mediation Of Farm Dispute File No. Telephone No. MEDIATOR'S CERTIFICATION IN PRELITIGATION FARM NUISANCE DISPUTE G.S. 7A-38.3B The undersigned mediator reports the following results in this prelitigation farm nuisance dispute. Mediation was conducted was not conducted was waived pursuant to G.S. 7A-38.3B(g) (See attached waiver.) If mediation was not conducted and a waiver is not attached, state the reason why the mediation was not held: List parties named on Request for Prelitigation Mediation of Farm Nuisance Dispute who are absent from mediation without good cause: If mediation was conducted, give date(s) on which mediation session was held Mediation resulted in agreement on all issues in dispute. agreement on some issues in dispute. an impasse. If there was a partial agreement only, the issues still in dispute are: Date Name Of Mediator (Type Or Print) Signature Of Mediator AOC-CV-823, Rev. 1/12 © 2012 Administrative Office of the Courts Original-File Copy-Each Party American LegalNet, Inc. www.FormsWorkFlow.com