Form Nhjb-2615-Sup - Appellate Mediation Program - Party Information Form - New Hampshire Supreme Court

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THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
New Hampshire Supreme Court
Court Name:
Case Name:
Case Number:
Date Appeal Filed:
(if known)
APPELLATE MEDIATION PROGRAM
PARTY INFORMATION FORM
Each party in a case referred to mediation must complete this form and submit it to the ADR Program
Coordinator by the date set forth in the Supreme Court order. A copy should also be sent to all other
parties.
Name of Party Filing Form:
Filing Status of Party Filing Form
:
(Check all that apply)
Appellant
Appellee
Cross Appellant
Cross Appellee
Pro Se
Other
If filing party is represented by counsel:
Name of Counsel:
Address:
Bar ID #:
Telephone:
E-mail:
If filing party is not represented by counsel:
Name of Person Filing Form:
Address:
Telephone:
E-mail:
Names and addresses of all other parties and counsel involved in this matter:
Name of Party:
Name of Counsel:
Address of Party:
Address of Counsel:
If this case or a related case has been appealed to the Supreme Court previously, please provide
case name and Supreme Court case number.
Identify any factors that may affect the suitability of case for mediation, including, but not limited to the
following factors:
Presents an issue of interpretation of state or federal constitution
Presents an issue of first impression
Presents an issue of validity of state statute, ordinance or agency regulation
Inconsistent with decisions of other trial courts
NHJB-2615-SUP (08/05/2016)
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