Request For Mediation And Order (6H)
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Request For Mediation And Order (6H) Form. This is a Oregon form and can be use in Circuit Court Statewide.
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Tags: Request For Mediation And Order (6H), Oregon Statewide, Circuit Court
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF
In the Matter of the Marriage of:
________________________________,
Petitioner,
and
________________________________,
Respondent.
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Case No. ______________________
REQUEST FOR MEDIATION and
ORDER
The parties to this case do not agree upon custody and/or parenting time. I, mother father, request
that the court send us to a mediator. The contact address and contact telephone for each parent is:
Mother:
Father:
Dated:
Petitioner Respondent, Signature
ORDER
Allowed.
Denied.
The parents are hereby ordered to contact and schedule a mediation with
by the following time/date :
.
DATED this ______ day of ___________________, 20_______.
Circuit Court Judge
Print Name
REQUEST FOR MEDIATION and ORDER - Page 1 of 2
6D-Z.MiscForms: 6H-Med-ReqVer02.doc (2/08)
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I certify that I mailed a true copy of this Request for Mediation to the other parent by placing a copy in a
stamped envelope in the US Mail on_________________(insert date of mailing) addressed to mother
father at the address listed above.
Certificate of Document Preparation. You are required to truthfully complete this certificate
regarding the document you are filing with the court. Check all boxes and 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.
Petitioner Respondent, Signature
Submitted by:
Petitioner Respondent, Print Name
Address or Contact Address
City, State, Zip
Telephone or Contact Telephone
REQUEST FOR MEDIATION and ORDER - Page 2 of 2
6D-Z.MiscForms: 6H-Med-ReqVer02.doc (2/08)
American LegalNet, Inc.
www.FormsWorkflow.com
