American LegalNet, Inc. www.FormsWorkFlow.com STATEMENT OF ARBITRABILITYPAGE 1 IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON IN AND FOR THE COUNTY OF MASON ) Plaintiff(s), ) NO. ) vs. ) STATEMENT OF ARBITRABILITY ) ) (STA) Defendant(s). ) ) CASE CATEGORY: COL - Commerical/Contract CONS - Construction MOD - Maintenance or Child Support Modification PIN - Personal Injury COM - Real Estate OTHER (Specify) STATEMENT OF ARBITRABILITY [ ] [ ] [ ] [ ] This case is subject to arbitration because the sole relief sought is a money judgment and involves no claim in excess of $,000.00, exclusive of attorney fees, interest and costs. This case is subject to arbitration because the sole relief sought is the establishment, termination, or modification of maintenance or child support payments. The undersigned contends that its claim exceeds $,000.00, but hereby waives any claim in excess of $,000.00 for the purpose of arbitration. RESPONSE TO STATEMENT OF ARBITRABILITY This case is not subject to mandatory arbitration because: American LegalNet, Inc. www.FormsWorkFlow.com STATEMENT OF ARBITRABILITYPAGE 2 [ ] Plaintiff's claim exceeds $,000.00. [ ] Plaintiff seeks relief other than a money judgment. [ ] Defendant's counter or cross claim exceeds $,000.00. [ ] Defendant's counter or cross claim seeks relief other than a money judgment. DATED SIGNATURE ATTORNEY FOR ATTORNEY FOR PLAINTIFF: ATTORNEY FOR DEFENDANT: Original to the Clerk of Court for filing, with a copy to Arbitration Supervisor, Mason County Superior Court, P.O. Box X, Shelton, WA 98584.