Alternative Dispute Resolution Statement To The Court

FOR CLERK'S USE ONLY Name of Person Filing: ________________________________________ Mailing Address: ________________________________________ City, State, Zip Code: ________________________________________ Phone Number(s): ________________________________________ ATLAS Number (if applicable) _____________________________________ Attorney Bar Number (if applicable) ________________________________ Self (Without an Attorney) OR Representing: Attorney for: Petitioner OR Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY _______________________________________ Petitioner/Plaintiff _______________________________________ Respondent/Defendant Case Number:_____________________________ ALTERNATIVE DISPUTE RESOLUTION STATEMENT TO THE COURT A.R.C.P. 16(g)(2) Check appropriate box below: Petitioner's Statement Respondent's Statement Joint Statement (signed by both parties) Pursuant to the Arizona Rules of Family Law Procedure, we hereby state the following, under penalty of perjury: 1. The parties agree to participate in the following Alternative Dispute Resolution (ADR) process and: a. have selected the following ADR process: Arbitration Mediation Settlement Conference Other: ________________________________________________________________ The parties will use a private provider OR, The parties request a program provided through the Court. The person or company providing the ADR service is: _______________________________ __________________________________________________________________________ The parties expect to complete the ADR process by ________________________, _______. The parties have been unable to agree on an ADR process. The Petitioner Respondent believe(s) that the following ADR process would be appropriate: ___________________________________. The Petitioner Respondent request(s) a conference to discuss ADR. The Petitioner Respondent believe(s) that an ADR process would not be appropriate for the following reason:_______________________________________________ ___________________________________________________________________________ b. c. d. 2. ___________________________ Date ___________________________ Date ________________________________________________________ Petitioner ________________________________________________________ Respondent 5/10/2012 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com