Nevada > County > Washoe > District Court > Family
Request For Mediation 2095 - Nevada
| Request For Mediation Form. This is a Nevada form and can be used in Family District Court Washoe County . |
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1 Code:2095 Name: __________________________________ 2 Address: _________________________________ __________________________________ 3 Telephone: _______________________________ Acting in Proper Person 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 ____________________________________, 11 Plaintiff, 12 vs. Case No. __________________13 ____________________________________, Dept. No. _________________14 Defendant. 15 _______________________________________/ 16 REQUEST FOR MEDIATION 17 __________________________________________, hereby requests that mediation be (Your name) 18 ordered in this matter for the purposes of attempting to formulate a viable Parenting Plan for the benefit19 of the minor child(ren): 20 _______________________________________ _________________ (Childs name) (Birthdate)21 _______________________________________ _________________22 _______________________________________ _________________23 _______________________________________ _________________24 It is further requested that I be allowed to participate in mediation by telephone due to the25 following circumstances: 26 ________________________________________________________________________________ 27 28 Ct. App. 7/99 1 <<<<<<<<<********>>>>>>>>>>>>> 2 1 ________________________________________________________________________________ 2 ________________________________________________________________________________ 3 ________________________________________________________________________________ 4 Date: ___________________________________ 5 _____________________________________ 6 (print name) 7 _____________________________________ (signature) 8 _____________________________________ 9 (address)10 _____________________________________11 _____________________________________ (telephone number)12 SUBSCRIBED and SWORN to before me 13 this __________ day of __________________, __________. 14 15 ___________________________________________ 16 NOTARY PUBLIC 17 18 19 20 21 22 23 24 25 26 27 28 Ct. App. 7/99 2
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