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Petition And Order For Relief From Obligation To Pay Mediators Fee CV-814 - North Carolina
| Petition And Order For Relief From Obligation To Pay Mediators Fee Form. This is a North Carolina form and can be used in Civil Statewide . |
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File No. STATE OF NORTH CAROLINA County In The General Court Of Justice Superior Court DivisionName Of Plaintiff(s) PETITION AND ORDER FOR VERSUS RELIEF FROM OBLIGATION TO PAY Name Of Defendant(s) MEDIATORS FEE G.S. 7A-38.1 PETITION The undersigned party petitions the Senior Resident Superior Court Judge for a finding of indigency and for relief from the obligation to pay a share of the mediators fee incurred in connection with the mediated settlement conference in the above case. Unpaid balance of my obligation $ Total value of my assets $ Total amount of my debts and liabilities $ I affirm to the Court that I am an indigent person who cannot pay this obligation. Name And Address Of Party (Type Or Print) Date Signature Of Party Telephone No. Plaintiff Defendant Third Party Defendant NOTE:The party requesting relief should file this Petition with the mediator at the conclusion of the settlement conference, and the mediator should attach the petition to the Report Of Mediator. ORDER The above petition to be relieved of the obligation to pay the mediators fee is: ALLOWED, and the moving party is relieved of the obligation to pay any mediators fee. DENIED, and the moving party is ordered to pay the mediators fee within thirty (30) days of the date of order. Date Name Of Senior Resident Superior Court Judge (Type Or Print)Signature Of Senior Resident Superior Court Judge NOTE:Upon entry of order, the original should be filed with the Clerk of Superior Court and copies mailed to the mediator and petitioner. AOC-CV-814, Rev. 3/99 1999 Administrative Office of the Courts
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