In The Court of Appeals For The First District of Texas NO. 01-___-__________-CV _________________________, Appellant(s) V. _________________________, Appellee(s) On Appeal from the __________ Court __________ County, Texas Trial Court Cause No. __________ MEDIATOR'S REPORT The Court referred this cause to mediation. ___________________________ served as mediator in this appeal based on the agreement of the parties. After the referral to mediation, the cause: American LegalNet, Inc. www.FormsWorkFlow.com  settled before the mediation was conducted. settled during mediation. did not settle. Check one of the following: Based on the agreement of the parties and the mediator, the mediator has been paid a fee as follows: $________________ paid by ________________________. $________________ paid by ________________________. $________________ paid by ________________________. $________________ paid by ________________________. The parties ask the Court to tax this fee as a cost of the appeal. The parties have agreed to another method of payment and understand that the Court will not tax this fee as a cost of appeal. _________________________________ Mediator's name: State Bar of Texas identification number: Mailing address: Telephone number: Fax number: 2 American LegalNet, Inc. www.FormsWorkFlow.com