MEDIATION 3 REQUEST FOR MEDIATION AND ORDER (FAMILY LAW CASE) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF DESCHUTES , Petitioner , v. , Respondent ) ) ) ) ) ) ) ) ) Case No. [Case Number] REQUEST FOR MEDIATION (FAMILY LAW CASE) I, , am the (mother) (father) of the child(ren) in this matter. We do not agree on custody and/or parenting time and I am therefore requesting that the Court send us to a mediator. I will take responsibility to see that the other parent receives a copy of this request as ction below. A restraining order is currently pending. I have concerns regarding my personal safety. Signed: Date: Notice to parents making this request: The Court requires you to give notice to the other parent. (date). Certificate of Document Preparation/ You are required to truthfully complete this certificate regarding the document you are filing with the Court. Check all boxes are complete all blanks that apply: I selected this document for myself and I completed it without paid assistance. I paid or will pay money to for assistance in preparing this form Signed: Date: Submitted by: Petitioner Respondent, Print Name Address or Contact Address American LegalNet, Inc. www.FormsWorkFlow.com