New Hampshire > Statewide > Family Division > Divorce And Parenting
Mediator Statement Divorce And Parenting NHJB-2681-F - New Hampshire
| Mediator Statement Divorce And Parenting Form. This is a New Hampshire form and can be used in Divorce And Parenting Family Division Statewide . |
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THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: MEDIATOR STATEMENT- DIVORCE AND PARENTING1 Name of Payee Address of Payee Name of Mediator if different from Payee Social Security or Federal I.D. Number of Payee TYPE OF BILLING: $300 Flat Fee for Mediation (5 hours Both parties Fund) $ $ $ Flat Fee for Mediation (5 hours One party fund) $150 Flat Fee for Mediation (5 hours One party fund) $ Sliding Scale fee, if any 2 ( hours of mediation services at $ per hour). $120 Failure to Appear Fee Mediation fee for reduced fee due to circumstances Mediation fee for reduced fee due to circumstances Divorce/Parenting Mediation payable through the Mediation fund (maximum compensation is $300) NOTE: Mediators must attach a copy of the order appointing them as mediator. I represent that the foregoing is a true and reasonable bill for services rendered. Date Signature of Mediator I hereby certify that I have examined the above statement and find the charge of $ to be reasonable. Recommended: Date Signature of Marital Master Printed Name of Marital Master So Ordered: I hereby certify that I have read the recommendation(s) and agree that, to the extent the marital master/judicial referee/hearing officer has made factual findings, she/he has applied the correct legal standard to the facts determined by the marital master/judicial referee/hearing officer. Date Signature of Judge Printed Name of Judge This form should be used when one or both parties have been approved to have the mediation fees paid through the Judicial Council Fund. Any amount billed after the initial fixed fee amount of $300.00 for 5 hours may only be billed after agreement by the parties and after a motion requesting the additional payment, consistent with the sliding scale, is granted by the Court. 2 1 NHJB-2681-F (01/01/2011) American LegalNet, Inc. www.FormsWorkFlow.com
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