Order Requiring Mediation Form
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2IN THE CIRCUIT COURT FOR THE STATE OF OREGON
FOR MULTNOMAH COUNTY
Family Law Department
_______________________________,
)
)
No._______________________
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Petitioner,
)
)
and
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ORDER REQUIRING MEDIATION
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_______________________________,
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)
Respondent.
)
Mother
Father
the Court
This matter came before the Court on the request of
or
__________________________________________. It appears that the parties disagree about a custody or
parenting time matter involving the child/ren. A hearing is scheduled for ______________________ date
not scheduled.
IT IS THEREFORE ORDERED under Supplemental Local Rule 12.015 of the Multnomah County
Circuit Court that the parties shall participate in mediation before a hearing occurs on the issue of custody or
parenting time. Failing to attend will likely delay the hearing or trial date. In some cases, it could also result in
sanctions affecting whether or how the non-attending party participates at the court hearing.
Both parties shall contact:
Multnomah County Family Services Division
Multnomah County Courthouse, Room 350
1021 SW Fourth Avenue
Portland, Oregon 97204
503/988-3189
[ ] for mediation on this date: _________________________, 20_____ at ________________a.m./ p.m.
[ ] immediately to schedule a date for mediation
Telephone number for the parties:
(Use a contact phone number if the other party does not have your phone number).
Mother ________________________________
Father ________________________________
DATED this ____ day of ________________, 20__.
______________________________
Circuit Court Judge
If you are a victim or domestic violence or if you otherwise have good cause, and you want to waive
mandatory mediation, you may request Waiver of Mediation forms in Room 211 of the Courthouse
or get them online at the website for the Multnomah County Circuit Court, Family Law pages.
OVER
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Revised 03/13/2013
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