File No. STATE OF NORTH CAROLINA In The General Court Of Justice District Court Division County Name Of Plaintiff Name Of Defendant MOTION AND ORDER TO RETURN TO CUSTODY MEDIATION VERSUS Date Of Original Custody Order G.S. 50-13.1 Date(s) Of Order(s) Modifying Original Order MOTION The parties move that this case be referred to the Custody Mediation Program for mediation of certain unresolved custody and visitation issues in this case, and in support of the motion state: 1. The custody order which was originally entered on the date shown above and modified on the subsequent shown above is currently in effect in this case. date(s) 2. Custody/visitation issues have arisen under the order. 3. The parties wish to resolve these issues without formal court proceedings and have consented to return to mediation to attempt to do so. Date Date Signature Signature Plaintiff Address Defendant Defendant's Attorney Plaintiff's Attorney Address ORDER The above Motion is allowed and it is ORDERED that this case be referred to the Custody Mediation Program for mediation of all unresolved custody and visitation issues in this case. The above Motion is denied. Date Signature Of Judge Name Of Judge (Type Or Print) AOC-CV-634, New 6/97 1997 Administrative Office of the Courts 2001 © American LegalNet, Inc.