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This is a Illinois form that can be used for Family Law within Local County, Lake.
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IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS IN RE THE MARRIAGE SUPPORT CIVIL UNION PARENTAGE ) ALLOCATION OF PARENTAL ) RESPONSIBILITIES ) ) ) ) ) ) ) ) ) Case No. ________________________ ____________________________________________________ vs. ___________________________________________________ MEDIATION REFFERAL ORDER Respondent Attorney for Minor Child Child Rep GAL Court The following parties are present: Petitioner and counsel Attorney for Minor Child Child Rep GAL Respondent and counsel It is hereby ordered that this matter is referred to: Mediator: Name: ________________________________________________________________________________________ Address: ______________________________________________________________________________________ Telephone: _____________________________________ Email: ____________________________________ On motion of: Petitioner Pursuant to: Supreme Court Rule 905 and Local Court Rule 4-3.19 for mediation. Issue(s) to be mediated: Allocation of Parental Responsibilities Modification of Allocation of Parental Responsibilities Parenting Time Abuse of allocated Parenting Time(750 ILCS 5/607.5) Relocation Other non-economic issues relating to the children. Specify: ____________________________________________________________________________________ __________________________________________________________________________________________ Economic issues involving the parties. Specify: ____________________________________________________________________________________ __________________________________________________________________________________________ Party A: Name of Party: _______________________________________________ Address of Party: _____________________________________________ Attorney for Party: _____________________________________________ Attorney's address: ____________________________________________ Party B: Name of Party: _______________________________________________ Address of Party: _____________________________________________ Attorney for Party: _____________________________________________ Attorney's address: ____________________________________________ GAL/AFC/CR Name: ______________________________________________________ Address: ____________________________________________________ Telephone: _____________________ Email: _________________________ Telephone: _____________________ Email: _________________________ Telephone: _____________________ Email: _________________________ Telephone: _____________________ Email: _________________________ Telephone: _____________________ Email: _________________________ THE PARTIES ARE ORDERED TO CONTACT THE APPOINTEE WITHIN TWO (2) BUSINESS DAYS TO SCHEDULE THE FIRST APPOINTMENT. Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 171-329 (Rev. 10/16) Fee allocation: Party A _______________% Orders of Protection: Party B ________________% The parties represent to the court as follows: (at least one box must be checked) No orders of protection have ever been entered involving the parties to this case, or The parties are, or have been in the past, involved in a proceeding(s) under the Illinois Domestic Violence Act. A current order of protection prohibits one of the parties from having any contact with the other party. Previous or current Orders of Protection involving either party: OP Case No. OP Case No: ______________ County: ________________ ______________ County: ________________ If the parties to mediation are subject to an order of protection which prohibits contact, they shall attend separate orientation and mediation sessions only. Notice to the Parties The parties are expected to mediate their dispute in good faith. Failure to attend a mediation session or failure to participate in mediation in good faith may subject a party to sanctions. Sanctions may include an assessment of mediation costs and/or attorney's fees incurred by the other party. The initial orientation session shall take place no later than 21 days from the date of this Order. The mediator shall inform the parties of their rights and obligations in mediation at the orientation session. Mediation shall terminate upon the following: When all issues have been resolved, or When an individual necessary to facilitate settlement of the dispute is not present, or When, in the opinion of the mediator, no purpose would be served by continuing the mediation, or When the mediator determines that an impairment exists that hinders the ability of the parties to negotiate safely, competently, or in good faith, or e. Upon order of court for good cause shown. Failure to appear on the date(s) scheduled and/or comply with the terms in this order may subject a party to sanctions pursuant to Supreme Court Rule 219(c), including but not limited to attorney's fees, monetary sanctions, and/or dismissal for want of prosecution. This matter is set for Status of Mediation on ___________________________ at 9:00 a.m. in C- _________________ the parties and their attorneys shall be present at this status hearing. Dated at Waukegan, Illinois this day of , 20 JUDGE Prepared by: Name: ____________________________________ Pro Se Address: __________________________________________ City: ______________________________ State: __________ Phone: ______________________Zip Code: _____________ ARDC #: __________________________________________ Fax: ______________________________________________ E-mail address: _____________________________________ Enter: a. b. c. d. Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 171-329 (Rev. 10/16)