COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : IN THE ______________COURT FOR ________________________, TENNESSEE JUDICIAL SUBPOENA Plaintiff(s) -against_______________________________________ Plaintiff VS. ________________________________________ Defendant Defendant(s) : : NO. ____________________ : : ...................................................... FINAL REPORT OF MEDIATOR Mediation was THE STATE OF NEW YORK THE PEOPLE OFordered on _______________________________________________________. Mediation was started on ________________________________________________________. TO Mediation was actually completed on ______________________________________________. GREETINGS: Result of referral to mediation (check all that apply): _______One or more parties did not appear or participate in the mediation WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before _______Both parties appeared and participated in the mediation. , the Honorable _______Case settled by mediation. at the Court located at County of _______Case settled as to all issues. in room , on the day of 20 o'clock in the noon, and at any recessed _______Case settled in, part. , at or adjourned date, to testify and give evidence as a witness in this action on the part of the _______Case did not settle. Name of Plaintiff’s attorney ______________________________________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the partyof Defendant’s attorney_____________________________________________________ Name on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Name, address, phone and fax number of mediator: ___________________________________ Witness, Honorable , one of the Justices of the _____________________________________________________________________________ Court in County, day of , 20 _____________________________________________________________________________ (Attorney must sign above and type name below) _____ Pro bono case _____ Fees paid at least in part by Parent Education and Attorney(s) fund (See T.C.A. § 36-6Mediation for 413(5). Attach an itemized invoice.) _____ Full fee case. I do _______ do not ________request that fees be charged as court costs. (Attach an itemized invoice) Office and P.O. Address ________________________________________ Mediator’s Signature Please file the original in the Clerk's office. ______________________ Date Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com