Form 50 - Information For Scheduling Mediation Prior To Setting Trial

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FORM 50 - OSCEOLA COUNTY
INFORMATION FOR SCHEDULING MEDIATION PRIOR TO SETTING TRIAL
(This form will expire in 30 days at which time it will be discarded. After that date you will need to refile.)
Date: _______________
Case No: ______________
Div. No.: ________
TYPE OF CASE: Divorce_____
Paternity _____
Modification _____
Temporary ______
Other (specify)______________________ Is either party certified as indigent? ______ If so, who?_________
Have the parties coordinated a date and time for the mediation conference? If so, please complete the following:
Date of Mediation: ________________ Time: ___________ Mediator(if applicable):_____________________
PETITIONER: _____________________________
RESPONDENT:_____________________________
(Please circle)
Mr.
Mrs.
Ms.
(Please circle)
Mr.
Mrs.
Ms.
YOUR ANNUAL GROSS INCOME: $____________
YOUR ANNUAL GROSS INCOME: $____________
Important Message to Self-Represented (Pro se) Litigants: If you fear that disclosing your address would put you in danger, write
“Confidential” on the address section of this form. You must complete a Request for Confidential Filing of Address Form, Florida
Supreme Court Approved Family Law Form 12.980(h), and file it with the Office of the Clerk of the Circuit Court in Osceola County.
ADDRESS:
ADDRESS:
(Attorney’s Address if you have an Attorney)
(Attorney’s Address if you have an Attorney)
________________________________________
__________________________________________
________________________________________
_________________________________________
DAYTIME TELEPHONE #____________________
DAYTIME TELEPHONE #______________________
FAX NUMBER_____________________________
FAX NUMBER_______________________________
E-MAIL:__________________________________
E-MAIL:____________________________________
ATTORNEY: _____________________________
ATTORNEY: ________________________________
G.A.L. (IF ANY):___________________________
GAL TELEPHONE NO:_______________________
GAL ADDRESS:___________________________________________________________________________
Please check the issues included in the Petition which are appropriate for mediation:
Parental responsibility _____;
Time-sharing _____;
Child support ____;
Exclusive possession of home_____; Equitable distribution(assets/debts) _____; Attorney fees ____;
Alimony/spousal support _____;
Other matters: _______________________________________.
Has either party ever received public assistance? ___ Receiving it now?_____ Type:____________
Have you ever been involved with any other family case
with this party? _______
(DIFFERENT CASE #)
If so, what is the case number? __________________ State or County of Origin: ________________
The mediation must be conducted within 30-45 days unless extended by both parties. In order to
obtain a date and time for a mediation conference, you may call the mediation office at (407)742-
2451 (preferably with the other side conferenced in, if possible) or you may complete the Form 50
and e-mail it to
or you may fax the Form 50 to (407) 835 - 5261.
ACKNOWLEDGEMENT: By signing this form I am declaring that to the best of my knowledge there is
no violence, threat of violence or substance abuse which would impede the mediation process. I
further understand that the Mediation Fee is determined by the combined annual gross income of the
parties (before deductions).
PERSON SUBMITTING FORM 50:__________________________
____________________________
PRINT NAME
SIGNATURE
Copies to: ____ Respondent (or Attorney)
____ Petitioner (or Attorney) ____ Domestic Clerk _____ GAL
Form 50-Osceola (Revised 05-2014)

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