Stipulated Request For Mediation And Order
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Stipulated Request For Mediation And Order Form. This is a Oregon form and can be use in Douglas Local County.
Loading PDF...
Tags: Stipulated Request For Mediation And Order, Oregon Local County, Douglas
IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR DOUGLAS COUNTY
In the M atter of the M arriag e of
__________________________________________,
Petitioner,
and
__________________________________________,
Respondent.
)
)
)
)
)
)
)
)
)
Case No. _______________________
STIPULATED REQUEST FOR
M EDIATION AND ORDER
Since it appears to both parents that custody and parenting tim e cannot be agreed upon:
( )
The parents request a referral to the Douglas County Mental Health Division for m ediation.
( )
The parents request the use of an independent m ediator. The m ediator has been contacted and has
a g re e d to m e d ia te , an d h a s a ls o a g re e d to a bid e b y the M e d ia tio n R u le s o f th is C o u rt.
The m ediator's nam e is ________________________________________________. The m ediator's
address and telephone num ber are:
_______________________________________________________
_______________________________________________________
The first m ediation appointm ent is scheduled for: _____________________________________
(M o n th /D ay/Year)
________________________________________
W ife's Signature
___________________________________
Husband's Signature
________________________________________
Address
___________________________________
Address
________________________________________
___________________________________
_______
State/Zip
Phone
City
State/Zip
Phone
City
________________________________________
W ife's Attorney and Bar Num ber
_________________________________________
__
Husband's Attorney and Bar Num ber
O RDER
IT IS HEREBY ORDERED, that
( )
The parents are referred to the Douglas County Mental Health Division for m ediation.
( )
The parents are to participate in m ediation with the independent m ediator set out above.
DATED this _________ day of _____________________________________, 200__.
________________________________________
JUDGE
DOU*DO-6:08/99
STIPULATED REQUEST FOR MEDIATION AND ORDER
American LegalNet, Inc.
www.USCourtForms.com
