Fill and Sign the Mediation 497300501 Form

 District Court  Denver Juvenile Court ________________________________ County, Colorado Court Address: In re:  The Marriage of:  The Civil Union of:  Parental Responsibilities concerning: ______________________________________________________ Petitioner/Plaintiff(s): and Co-Petitioner/Respondent/Defendant(s): 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 The  Petitioner/Plaintiff(s) and/or  Co-Petitioner/Respondent/Defendants(s) request(s) an exemption from Mediation/ADR 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/Plaintiff or  Co-Petitioner/Respondent/Defendant is unwilling to enter into mediation services or dispute resolution programs because she/he is the victim of physical or psychological abuse by the other party.  Mediation or ADR is not appropriate in this case because: ____________________________________________________________________________________ ____________________________________________________________________________________ ________________________________________________________________________________  By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form.  By checking this box, I am acknowledging that I have made a change to the original content of this form. (Checking this box requires you to remove JDF number and copyright at the bottom of the form.) ______________________________________ _____________________________________________ Petitioner/Plaintiff Date Co-Petitioner/Respondent/Defendant Date ______________________________________ ____ _________________________________________________ Petitioner’s/Plaintiff’s Attorney Signature, if any Co-Petitioner/Respondent’s/Defendant’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 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 608 R8/17 MOTION RE: EXEMPTION FROM MEDIATION/ADR ORDER ©2017 Colorado Judicial Department for use in the Courts of Colorado