Custody Mediation Cover Sheet {WAKE-DOM-06}

STATE OF NORTH CAROLINA COUNTY OF WAKE Name and Address of Plaintiff IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION FILE NO: ____________________ Phone No: Name and Address of Plaintiff's Attorney CUSTODY MEDIATION COVER SHEET Attorney's Phone No: Assigned Judge: ______________________________ VERSUS Name and Address of Defendant Phone No: Name and Address of Defendant's Attorney ATTACH A COPY OF ALL DOMESTIC VIOLENCE RESTRAINING ORDERS (CIVIL OR CRIMINAL), IF ANY [ ] NO [ ] NO Phone No: Have the parties previously attended a group orientation? [ ] YES Have the parties previously attended custody visitation mediation? [ ] YES Is there a pending or resolved civil or criminal domestic violence case involving the same parties in NC or any other State? [ ] YES [ ] NO If yes, attach a copy of all civil or criminal domestic violence restraining orders? Signature of Party Filing Cover Sheet Note: MUST BE FILLED OUT COMPLETELY CMO USE ONLY Orientation Date: Mediation Date: WAKE-DOM-6 (Rev. 2/06) American LegalNet, Inc. www.USCourtForms.com