IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF MULTNOMAH 1021 SW 4TH AVENUE, PORTLAND OR 97204 Plaintiff/Petitioner vs. Defendant/Respondent Case No. REQUEST FOR APPOINTMENT OF ARBITRATOR Plaintiff has taken the following unsuccessful steps to reach agreement with the other parties regarding the selection of an arbitrator: Despite these efforts, plaintiff has been unable to reach agreement with the other parties and therefore requests that the Court appoint an arbitrator. Plaintiff has attached to this form a copy of the list of proposed arbitrators with no more than two of the names crossed out. Plaintiff has served a copy of the proposed list upon all other parties and by copy of this form given them notice that if they wish to participate in the selection of the arbitrator by the Court they must submit to the Court within seven days a copy of the list from which each may cross out no more than two names. The Court will select an arbitrator from among the remaining names. Date: Plaintiff, or Attorney for Plaintiff 30-16 (5/15) REQUEST FOR APPOINTMENT OF ARBITRATOR American LegalNet, Inc. www.FormsWorkFlow.com