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Original - Clerk Copy - Petitioner Copy - Mediator Copy - Persons/Entities Ordered to Attend Mediation (Over) The above named matter was referred to mediation and the parties h ad days to select a certified mediator. After a full and frank discussion, the parties have been unable to agree upon the selection of a certified mediator. Pursuant to Rule 2.B. of the Rules of Clerk Mediation Program, the p etitioner moves the Clerk of Superior Court to appoint: DESIGNATION OF MEDIATOR IN MATTER BEFORE CLERK OF SUPERIOR COURT STATE OF NORTH CAROLINA County File No. AOC-G-302T, New 3/06 © 2006 Administrative Office of the Courts In The General Court Of Justice Superior Court Division Before The Clerk SECTION 2 - MOTION FOR CLERK APPOINTMENT OF CERTIFIED MEDIATOR SIGNA TURE Name Of Person/Ent it y Filing Designat ion Signature Of Person/Entity Filing Designation Date a certified Superior Court or Family Financial Mediator; or because this is an estate or guardianship matter, a mediator who has co mpleted estate and guardianship mediation training and is certified to mediate such matters. 1. 2. 3. a. b. As an aid to mediator selection, the NC Dispute Resolution Commission main tains a list of mediators available to conduct mediations in matters referred by the Clerk on its web site at www.ncdrc.org . Click on "List of Mediators" from the left-hand menu, then click on "Clerk Program Mediators." You may select either a certif ied Superior Court or Family Financial Mediator or if you are seeking a mediator for an estate or guardianship matter, you must select a mediator with estate and guardianship mediation training. You may search for mediators by name of mediat or or by county. Once a mediator's name appears on your screen, click on it for a complete contact and availability listing. NOTE: The above named matter was referred to mediation. The parties have selected the mediator named below who has agreed to serve in this matter and is eligible to serve pursuant to the Rules of the Clerk Mediation Program. If this is an estate or guardianship matter, the mediator has completed at least ten hours training in mediating e state and guardianship matters and is certified to mediate estate and guardianship matters. SECTION 1 - NOTICE OF SELECTION OF CERTIFIED MEDIATOR BY AGREEMENT The parties and the mediator have agreed upon the mediator's rat e of compensation as follows: (specify all terms of the compensation agreement.) Name And Address Of Certified Mediator Telephone No. NOTICE: Fill out only one of the two Sections, sign below, and return to the Clerk of Superior Court within days after the da te of the Order for Mediation and distribute copies as noted below. G.S. 7A-38.3B; Rules 2 and 8 of Rules Implementing Mediation In Matters Before Clerk Of Superior Court Name Of Petitioner Name Of Respondent/Decedent VERSUS (IN THE MATTER OF:) Name And Address Of Petitioner's Attorney (Or Pro Se Petitioner) Name And Address Of Respondent/Decedent's Attorney (Or Pro Se Respondent/Decedent) Telephone No. Telephone No. Hearing Date Deadline For Completion Of Mediation Yes No Agreement, if reached, to be submitted to Clerk. Clerk Of Superior Court a mediator who has completed estate and guardianship mediation training and is certified to mediate estate and guardianship matters. AOC-G-302T, Side Two, New 3/06 © 2006 Administrative Office of the Courts ORDER OF APPOINTMENT The parties having reported their failure to agree upon the selectio n of a mediator, or the parties having failed to timely notify the Clerk of their selection after this matter was ordered to mediation, the Clerk app oints the following to conduct this mediation NOTICE TO MEDIATOR: The mediator shall be responsible for reserving a place and making arrange ments for the mediation and giving timely notice to all attorneys and unrepresented parties of the time and location of the mediation. The mediation shall be completed by the completion deadline set forth above, and the mediator shall report the results of the conference to the Clerk within ten (10) days after the mediation is completed. Telephone No. Signature Of Clerk a Certified Superior Court or Family Financial Mediator Name And Address Of Mediator Assistant CSC Name Of Clerk (Type Or Print) Date