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Stipulated Request For Mediation And Order - Oregon
| Stipulated Request For Mediation And Order Form. This is a Oregon form and can be used in Circuit Court Douglas Local County . |
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IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR DOUGLAS COUNTY In the M atter of the M arriag e of __________________________________________, Petitioner, and ) ) ) ) ) ) ) ) ) Case No. _______________________ STIPULATED REQUEST FOR M EDIATION AND ORDER __________________________________________, Respondent. Since it appears to both parents that custody and parenting tim e cannot be agreed upon: () () The parents request a referral to the Douglas County Mental Health Division for m ediation. The parents request the use of an independent m ediator. The m ediator has been contacted and has a g re e d to m e d ia te , an d h a s a ls o a g re e d to a bid e b y the M e d ia tio n R u le s o f th is C o u rt. The m ediator's nam e is ________________________________________________. The m ediator's address and telephone num ber are: _______________________________________________________ _______________________________________________________ The first m ediation appointm ent is scheduled for: _____________________________________ (M o n th /D ay/Year) ________________________________________ W ife's Signature ________________________________________ Address ________________________________________ City State/Zip Phone City ___________________________________ Husband's Signature ___________________________________ Address ___________________________________ _______ State/Zip Phone ________________________________________ _________________________________________ __ Husband's Attorney and Bar Num ber W ife's Attorney and Bar Num ber ORDER IT IS HEREBY ORDERED, that () () The parents are referred to the Douglas County Mental Health Division for m ediation. The parents are to participate in m ediation with the independent m ediator set out above. DATED this _________ day of _____________________________________, 200__. ________________________________________ JUDGE DOU*DO-6:08/99 STIPULATED REQUEST FOR MEDIATION AND ORDER American LegalNet, Inc. www.USCourtForms.com
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