IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT
LAKE COUNTY, ILLINOIS
)
)
______________________________________________ )
Petitioner,
)
vs.
)
Case No.
)
Previous or current OPs involving either of the parties:
)
______________________________________________ )
OP Case No: ________________
County: ______________
Respondent. )
OP Case No: ________________
County: ______________
ORDER OF REFERRAL TO MEDIATION
Pursuant to Local Rule 11.13, the parties are ordered to participate in mediation.
Mediator:
Name: ________________________________________________________________________________________
Address: ______________________________________________________________________________________
Telephone: _____________________________________
Fax: ______________________________________
Issue(s) to be mediated:
Initial Custody
Modification of custody
Visitation schedule
Visitation abuse issues pursuant to 750 ILCS 5/607.1
Removal
Joint custody pursuant to 750 ILCS 5/602.1
Other non-economic issues relating to the children.
Specify: ____________________________________________________________________________________
__________________________________________________________________________________________
Economic issues involving the parties.
Specify: ____________________________________________________________________________________
__________________________________________________________________________________________
This matter is set for Status of Mediation on ___________________________ at ___________M in C- ____________
The parties are ordered to contact the mediator within two business days of this order.
The parties shall participate in an orientation session which shall take place no later than 21 days from the date of this order.
The parties shall return to court for the Status of Mediation on the date set forth above.
Party A:
Name of Party: _______________________________________________
Telephone: _____________________
Address of Party: _______________________________________________________________________________
Attorney for Party: _____________________________________________
Telephone: _____________________
Attorney’s address: ____________________________________________
Fax: ___________________________
Party B:
Name of Party: _______________________________________________
Telephone: _____________________
Address of Party: _______________________________________________________________________________
Attorney for Party: _____________________________________________
Telephone: _____________________
Attorney’s address: ____________________________________________
Fax: ___________________________
GAL/AFC/CR
Name: ______________________________________________________
Telephone: _____________________
Address: ____________________________________________________
Fax: ___________________________
Fee allocation: Party A _______________%
Party B ________________%
This is a low-income case and the mediator shall provide services at a reduced fee:
Hourly rate: ___________
Total fee: ___________
Page 1 of 2
171-329 (Rev. 06/13)