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Fill and Sign the Fillable Online Co Hubbard Mn Exhibit B Form of Request

Fill and Sign the Fillable Online Co Hubbard Mn Exhibit B Form of Request

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Court telephone no. MC 282 (3/08) DOMESTIC VIOLENCE SCREENING FOR REFERRAL TO MEDIATION Approved, SCAO STATE OF MICHIGAN CASE NO. Court addressDOMESTIC VIOLENCE SCREENING FOR REFERRAL TO MEDIATION Plaintiff's name Defendant's name Date Signature Plaintiff's attorney, bar no., address, and telephone no. Defendant's attorney, bar no., address, and telephone no. v Note: If you have an attorney, this form should be completed with your attorney. Please return this completed form to the ADR clerk at the above court address within 7 business days. Instructions: If there are any actions involving you or the other party, specify the names of the persons involved, the case nu mber, the name of the court where the action was filed, including the county and state. If there are no actions, write "NONE." 1. I am aware of the following personal protection actions involving myself and/or the other party: 2. I am aware of the following domestic violence criminal actions involving myself and/or the other party: 3. I am aware of the following pending child protective (abuse/neglect) actions involving myself and/or the other party: JUDICIAL DISTRICT JUDICIAL CIRCUIT COUNTY PROBATE

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