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Include the following notice if a minor is named in the caption or if the order contains other unredacted sensitive data. See § 6 of the Introduction in volume 1 of this manual concerning protection of sensitive data in filed documents. |
NOTICE: THIS DOCUMENT
CONTAINS SENSITIVE DATA
[Caption. See § 3 of the Introduction in volume 1 of this manual.]
Order Concerning Court-Appointed Mediator
By order of this Court, [name] was appointed to serve as mediator, for which a fee was paid. The case [was settled at mediation/has reached an impasse and did not settle at this session].
The following mediation fees were agreed on by the parties to the mediation and by the mediator and were paid in the following amounts and by the parties as indicated: [list amounts paid and the payor for each amount].
Respectfully submitted on [date].
[Name]
Mediator
State Bar No.:
[Email address]
[Address]
[Telephone]
[Fax]
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The total compensation requested and already paid is approved as submitted. |
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An additional $ ____________ is to be paid on or before ________________________ by ______________________________. |
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An additional $ ____________ is to be paid on or before ________________________ by ______________________________. |
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ORDERED on ______________________________.
JUDGE PRESIDING
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Forms 18-21 through 18-30 are reserved. |