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FORM G. CLOSING FORM

Effective Date: 1/1/2001

STATE OF NORTH DAKOTA IN DISTRICT COURT

COUNTY OF __________________ ___________________JUDICIAL DISTRICT

A.B,
Plaintiff,

vs.

C.D.,
Defendant

 )
)
)
)		 FAMILY MEDIATION PROGRAM
CLOSING FORM

No mediation due to:

Mediation outcome - parental rights and responsibilities only
_____ Agreement reached on all issues
_____ Agreement reached on some issues
_____ No agreement reached

Mediation outcome - other issues in case
Were other issues present in the case? ____Yes _____No
Did parties mediate other issues: ____Yes ____ No

_____ Agreement reached on all other issues raised by parties
_____ Agreement reached on some other issues raised by parties
_____ No agreement reached on other issues raised by parties

Mediator's name_________________________________________

Signature:______________________________________________

Date _________________________

cc: The Court, Family Mediation Program Administrator, Parties/Attorneys

Effective Date Obsolete Date
01/01/2001 View