Form 50 - Information For Scheduling Mediation printable pdf download

INFORMATION FOR SCHEDULING MEDIATION

Date: _______________________ Case No.:_____________________

Judge: ______

Type of Case:

_____ DIVORCE _____PATERNITY ______MODIFICATION

CERTIFIED BY THE CLERK AS INDIGENT/INSOLVENT: ___ Petitioner _____ Respondent

SPANISH SPEAKING MEDIATOR BEING REQUESTED? : _____ Yes _____No

PETITIONER: _____________________________ RESPONDENT: _________________________________

PETITIONER ANNUAL INCOME $___________ RESPONDENTS ANNUAL INCOME $____________

ATTORNEY: ___________________________

ATTORNEY: __________________________________

Address for attorney or if not attorney, for the party:

Address for attorney or if not attorney, for the party

Address: _________________________________

ADDRESS: ____________________________________

________________________________________

_____________________________________________

DAYTIME TELEPHONE #:________________

DAYTIME TELEPHONE #_______________________

EMAIL ___________________________________ EMAIL_______________________________________

FAX NUMBER _________________________

G.A.L. (IF ANY) _________________________

G.A.L. TELEPHONE #__________________________

G.A.L. ADDRESS: _______________________________________________________________________

Please check all contested issues included in the Petition which are appropriate for mediation:

____parental responsibility ____timesharing ____ child support ____ exclusive possession of home

_____visitation ____ alimony ____children school issues _____other matters_____________________________

Have the parties been involved in any current or previous litigation? _____________

If so, what is the case number _____________________ State/County or Origin ______________________

Mediation will contact parties within 20 business days, if not sooner, after receipt of this form. The Court

will issue an Order of Referral Setting Case for Mediation and provide to the parties by email, fax or U.S.

mail. Mediation session(s) will be scheduled for a maximum of three (3) hours. Fill out both parties

information. ONLY ONE SIGNATURE REQUIRED FOR SUBMISSION IF OPPOSING PARTY COPIED.

______________________________________

_______________________________________

Attorney/Petitioner

Attorney/Respondent

Fax completed form to: (407) 665-4129 or Email to

Mail to: Family Mediation Department; 301 N. Park Ave., Sanford, FL 32772

Cc:

_____Petitioner/Petitioners Attorney

_____Respondent/Respondents Attorney

**PARTIES REPRESENTING THEMSELVES MAY BE SCHEDULED BY THE COURT**

Form 50

Form 50 - Information For Scheduling Mediation