Nevada > County > Washoe > District Court > Family
Private Mediation Referral Order - Nevada
| Private Mediation Referral Order Form. This is a Nevada form and can be used in Family District Court Washoe County . |
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1 CODE 2 3 4 5 6 IN THE FAMILY DIVISION 7 OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA 8 IN AND FOR THE COUNTY OF WASHOE 9 ________________________________, 10 Plaintiff, 11 vs. Case No.12 ________________________________, Dept. No. 13 Defendant. __________________________________/ 14 15 PRIVATE MEDIATION REFERRAL ORDER 16 I swear under penalty of perjury that the foregoing is true. 17 The parties have contacted me, _____________________________, to conduct private18 mediation. 19 My qualifications as a Mediator are as follows: 20 _________________________________________________________________________21 _________________________________________________________________________22 _________________________________________________________________________23 _________________________________________________________________________24 _________________________________________________________________________25 _________________________________________________________________________26 _________________________________________________________________________27 _________________________________________________________________________ (Please attach another sheet if needed) 28 <<<<<<<<<********>>>>>>>>>>>>> 2 1 I have set up an orientation and initial conference with the parties on the _____ day of 2 ________________________, 20____. 3 I have read and understand Washoe District Court Rules 53 and 54, regarding 4 mediation. 5 Upon completion of mediation, I will provide to the Court a Mediation Report. If 6 mediation was unsuccessful, I will immediately submit a report that mediation was 7 unsuccessful and, therefore, concluded. If mediation is successful, the parties agreement 8 shall be reduced to writing, signed by the parties and submitted to the Court for approval within 9 ten (10) days. 10 DATED this ______ day of _____________________________, 20____. 11 ________________________________ ___________________________________ Signature of Mediator Address 12 ________________________________ ___________________________________13 Phone Number 14 _____ The Court GRANTS the parties request for a private mediator. 15 _____ The Court DENIES the parties request for a private mediator. 16 _____ There is a history of domestic violence. 17 _____ There is a history of child abuse/neglect. 18 _____ Other: ___________________________________________________ 19 _________________________________________________________________________ 20 DATED this ______ day of _____________________________, 20____. 21 22 23 ______________________________ DISTRICT JUDGE24 25 26 27 28 - 2 -
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