Fill and Sign the Exemption Mediation Form

 District Court  Denver Juvenile Court ___________________________ County, Colorado Court Address: In re:  The Marriage of:  The Civil Union of:  Parental Responsibilities concerning: ______________________________________________________ Petitioner: and Co-Petitioner/Respondent: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom MOTION RE: EXEMPTION FROM MEDIATION/ADR ORDER (DOMESTIC RELATIONS CASE) The  Petitioner and/or  Co-Petitioner/Respondent request(s) an exemption from the Mediation/ADR Order in this case, for the following reason(s):  The parties attempted mediation or ADR _________________________ (specify ADR process) on __________________________ (date) and believe that additional mediation or ADR would not be useful.  The  Petitioner or  Co-Petitioner/Respondent is unwilling to enter into mediation services or dispute resolution programs because s/he is the victim of physical or psychological abuse by the other party.  Mediation or ADR is not appropriate in this case because: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ______________________________________ _____________________________________________ Petitioner Date Co-Petitioner/Respondent Date ______________________________________ _____________________________________________ Petitioner’s Attorney Signature, if any Co-Petitioner’s/Respondent’s Attorney Signature, if any CERTIFICATE OF SERVICE (Required if only one of the parties is filing the Motion.) I certify that on __________________________ (date) the original was filed with the Court; and, a true and accurate copy of the Motion re: Exemption from Mediation/ADR Order (Domestic Relations Case) was served on the other party by:  Hand Delivery  E-filed  Faxed to this number ___________________ or  by placing it in the United States mail, postage pre-paid, and addressed to the following: To: ______________________________________ ______________________________________ ______________________________________ ______________________________________ Your Signature JDF 1307 R713 MOTION RE: EXEMPTION FROM MEDIATION/ADR ORDER (DOMESTIC RELATIONS CASE) © 2013 Colorado Judicial Department for use in the Courts of Colorado