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Request For Mediation By One Parent Form. This is a Oregon form and can be use in Douglas Local County.
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Tags: Request For Mediation By One Parent, Oregon Local County, Douglas
IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR DOUGLAS COUNTY
In the Matter of the Marriage of:
__________________________________________,
Petitioner,
and
__________________________________________,
Respondent.
)
)
)
)
)
)
)
)
Case No._______________________
REQUEST FOR MEDIATION BY ONE PARENT
(SLR 12.025 (1) (b))
I, ________________________________________, am the (m other) (father) of the child(ren) of this
m arriage. W e cannot agree upon custody and/or parenting tim e, and I am requesting that the Court send us
to a m ediator. I am , therefore, filing this Request for Mediation by One Parent. I have kept a copy. I have
taken the responsibility to see that m y spouse receives a copy of this request as indicated in the "NOTICE"
section below. The other parent's current address is:
.
DATED: ________________________
SIGNED: ________________________________________
(Mother) (Father), Pro se
____________________________________________
(Address)
____________________________________________
(City/State)
(Zip)
____________________________________________
(Telephone)
DOU*DO-7:8/99
PAGE 1 - REQUEST FOR MEDIATION BY ONE PARENT
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IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR DOUGLAS COUNTY
In the Matter of the Marriage of:
__________________________________________,
Petitioner,
and
______________________________________________,
Respondent.
)
)
)
)
)
)
)
)
Case No._______________________
REQUEST FOR MEDIATION BY ONE PARENT
ORDER
(SLR 12.025 (1) (b))
ORDER:
[ ]
The parents are referred to the Douglas County Mental Health for m ediation.
[ ]
Request for m ediation is denied.
DATED this __________ day of _____________________________________, 200__.
__________________________________________
___________________________________
____
JUDGE
NOTICE TO PARENT MAKING THIS MOTION : The Court also requires you to GIVE NOTICE TO THE
OTHER PARENT, or his/her attorney. (See back for details.)
DOU*DO -7:8/99
ORDER
PAGE 2 - REQUEST FOR MEDIATION BY ONE PARENT
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SERVICE
(Do not sign until you are in the presence of a Notary Public or Clerk of the Court.)
PERSONAL NOTICE: (The Mother, or the Father, or any other adult m ay give the copy to the other parent,
and should then com plete the section below and return it to the Clerk's office to be filed.)
STATE OF OREGON
County of Douglas
)
) ss.
I, _______________________________, hereby swear that I gave an exact and true copy of this Request for
Mediation by One Parent to the other parent, ________________________________________, who is the
(m other) (father), by personally handing it to him /her.
DATE GIVEN TO OTHER PARENT: ________________________
SIGNED: _________________________________________
(Sign only before a Notary or Clerk)
M AIL NOTICE: (The Mother, or the Father, or any other adult m ay m ail the copy to the other parent, and
should then com plete the section below.)
I, _____________________________, hereby swear that I could not personally hand a copy of this Request
for Mediation by One Parent to the other parent, so I m ailed a true, exact and full copy of it to him /her as
follows:
DATE MAILED: _________________ TIME: __________ AT: _____________________________________
(City, State)
I m ailed it to the other parent's last known m ailing address, which is:
__________________________________________
Street
__________________________________________
City, State and Zip Code
SIGNED:
__________________________________________
(Sign only before a Notary or Clerk)
SUBSCRIBED AND SW ORN TO BEFORE ME THIS _________ day of ____________________________,
200__.
__________________________________________
NOTARY PUBLIC/CLERK
My Com m ission Expires: ______________________
PAGE 3 - REQUEST FOR MEDIATION BY ONE PARENT
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