IN THE ____________________ COURT FOR ____________________ COUNTY, AT __________________________, TENNESSEE __________________________________, Plaintiff, vs. CIVIL ACTION/DOCKET NO.: __________________________________, Defendant ORDER FOR REDUCED FEE MEDIATION The Court, having determined that referral to mediation is appropriate in this case either on the Court’s own motion or on the motion of one of the parties, and the Court having determined that the [ ] Plaintiff and/or [ ] Defendant has/have filed the present case in forma pauperis, it is hereby ORDERED that in accordance with Rule 31 of the Rules of the Tennessee Supreme Court that mediation will be conducted upon the following issue(s): all matters pertaining to this pending divorce; and it is further ORDERED that both parties shall participate in mediation. Attorneys may participate as agreed by the parties and mediator; and it is further ORDERED that the mediator shall file a report pursuant to Sections 8 and 12(j) of Rule 31 with the Clerk of the ______________ Court for ___________County, Tennessee; and it is further ORDERED that the attorneys will file an Order reflecting any agreement reached as a result of a successful mediation within ten (10) days of the mediation; and it is further ORDERED that the fees of the mediator will be set at $50.00 per hour for in session 9/05 American LegalNet, Inc. www.USCourtForms.com ($25.00 per hour per party) and $40.00 per hour for out of session work ($20.00 per hour per party) with a total fee to be charged set at no more than that amount to compensate a maximum of ten (10) hours of in session work and out of session work in the aggregate; and it is further ORDERED that the [ ] Plaintiff in this case shall pay ______ per hour for in session and ______ per hour for out of session work by the mediator. The [ ] Defendant in this case shall pay ______ per hour for in session and ______ per hour for out of session work by the mediator The balance of the [ ] Plaintiff’s and/or [ ] Defendant’s mediator fee in this case shall be paid from the Divorcing Parent Education and Mediation Fund (T.C.A. §36-6-413) in accordance with Tennessee Supreme Court Rule 38; and it is further ORDERED that a copy of this order be forwarded to the mediator along with a Mediator Claim for Reimbursement from Divorcing Parent Education and Mediation Fund (T.C.A. §36-6-413) for Reduced Fee Mediation; and it is further ORDERED that the mediator file a claim for the mediation fee with the Administrative Office of the courts with a completed Mediator Claim for Reimbursement from Divorcing Parent Education and Mediation Fund (T.C.A. §36-6-413) for Reduced Fee Mediation attached to this Order; and it is further ORDERED that the parties and their counsel shall proceed in a good faith effort to resolve the issues in this case. The mediation shall be private and confidential. Everything said or done in the mediation is confidential and may not be used in any subsequent judicial proceedings, except as allowed by statute. Allegations of child abuse or threats of future harm shall not be confidential. ENTERED this _____________ day of ____________________, 20____. ___________________________________ JUDGE /// 9/05 American LegalNet, Inc. www.USCourtForms.com APPROVED FOR ENTRY: ____________________________________ Attorney for [ ] Plaintiff or [ ] Defendant ____________________________________ (Address) ____________________________________ (Address) ____________________________________ (City/State/Zip) ____________________________________ (Phone) CERTIFICATE OF SERVICE I hereby certify that the foregoing has been delivered by U.S. Mail to the parties in this action or their attorney of record on this _______ day of ________________, 2003, as follows: _____________________ [ ] Plaintiff or [ ] Attorney _____________________ (Address) _____________________ (Address) _____________________ (City/State/Zip) _____________________ [ ] Defendant or [ ] Attorney ___________________ (Address) ___________________ (Address) ___________________ (City/State/Zip) __________________________________ Clerk/Notary Public 9/05 American LegalNet, Inc. www.USCourtForms.com