Report Of Mediator

FORM #5 United States Bankruptcy Court Western District of Michigan {INSERT BANKRUPTCY CASE/ADVERSARY PROCEEDING CAPTION} REPORT OF MEDIATOR The mediator must submit this report within 14 days of completing mediation or determining mediation is inappropriate. 1. 2. Mediation was determined inappropriate. OR Mediation was completed on The participants were: ______________________________________________ on behalf of ______________________________________________ ______________________________________________ on behalf of ______________________________________________ ______________________________________________ on behalf of ______________________________________________ ______________________________________________ on behalf of ______________________________________________ ______________________________________________ on behalf of ______________________________________________ ______________________________________________ on behalf of ______________________________________________ 3. This case was: NOT SETTLED and further ADR proceedings are: contemplated not contemplated. SETTLED. Final settlement documents to be filed by ___________________ by ___________________________________. Date Name of Filer Date . _________________________________ Date ________________________________________________________ Mediator Signature ________________________________________________________ Mediator name (type or print) American LegalNet, Inc. www.FormsWorkFlow.com