Request For Mediation {9019-2}

LOCAL BANKRUPTCY FORM 9019-2 IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : : : : : : : : : : : : : : : CHAPTER CASE NO. -bk- Debtor(s) ADVERSARY NO. (if applicable) - -ap- Plaintiff(s)/Movant(s) vs. Nature of Proceeding: Pleading: Defendant(s)/Respondent(s) Document #: REQUEST FOR MEDIATION* CHECK ONE: G The undersigned requests this dispute be assigned to mediation. G The undersigned certifies that the other party or parties to the dispute join in this request. (Check if applicable.) Contemporaneously with the filing of this request, the undersigned has served a copy of this request upon all the parties or their respective legal counsel. Dated:______________________ _____________________________________ Attorney for___________________________ *No alterations or interlineations of this document are permitted. American LegalNet, Inc. www.FormsWorkFlow.com