Form Nhjb-2615-Sup - Appellate Mediation Program - Party Information Form - New Hampshire Supreme Court Page 2

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Case Name:
Case Number:
APPELLATE MEDIATION PROGRAM – PARTY INFORMATION FORM
History of settlement negotiations, if any (Including a listing of previous demands and offers):
Description of monetary, physical injury, or any other damages upon which the claim is based:
Out-of-pocket expenses upon which the claim is based:
I hereby certify that, on or before the date below, copies of this form were served on all parties to the
case.
Date
Party or Counsel
Send completed form to:
New Hampshire Judicial Branch Administrative Offices
Attention: Appellate Mediation Program
1 Granite Place, Suite N400
Concord NH 03301
Top of 1st Page
NHJB-2615-SUP (08/05/2016)

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