IN THE UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF PENNSYLVANIA ) Bankruptcy No. _________________________ ) ) ) ) Motion No. _____________________________ ______________________________________, ) ) Adversary No. ___________________________ Plaintiff/Movant ) vs. ) ) _______________________________________ ) Defendant/Respondent ) _______________________________________ ) In re: ______________________________________, Debtor _______________________________________ MEDIATOR'S CERTIFICATE OF COMPLETION OF MEDIATION CONFERENCE 1. I hereby certify that pursuant to an order of assignment of this Court to the Bankruptcy Mediation Program dated _________________________, a Mediation Program Conference was held on ________________________________________________________________________/was not held. (list all date(s) on which conference was held) 2. A settlement/resolution of this matter was _____/was not____ reached. Dated: ___________________________ Mediator:________________________________________ Signature Type or print: Name:_____________________________________ Address:___________________________________ __________________________________________ Telephone:_________________________________ PAWB Local Form 32 (07/13) American LegalNet, Inc. www.FormsWorkFlow.com