Fill and Sign the Versus in the Matter of Form

In accordance with Rule 1.C.(3), this motion has been filed by a party, interested person or fiduciary in this matter and served in accordance with Rule 5 of the N.C.R.C.P. on non-moving parties, interest ed persons, and fiduciaries designated by the Clerk of Superior Court or identified by the petitioner in the pleadings as evidenced by the completed "Certificate of Service." Objections to the Motion may be filed in writing within five (5) days after date of service. Original-Clerk Copy-Mediator Copy-Petitioner Copy-Respondent STATE OF NORTH CAROLINA County File No. In The General Court Of Justice Superior Court DivisionBefore The Clerk AOC-G-300T, New 3/06 © 2006 Administrative Office of the Courts The below named moves the Clerk of Superior Court to order that a med iation be held in this matter for the following reasons: SIGNATURE Name Of Person/Entity Filing Motion Signature Of Person/Entity Filing Motion Date MOTION FOR AN ORDER TO MEDIATE MATTER BEFORE THE CLERK G.S. 7A-38.3B; Rule 1.C.(3) Of The Rules Implementing Mediation In Matters Before The Clerk Of Superior Court Name Of Petitioner Name Of Respondent/Decedent VERSUS (IN THE MATTER OF:) Name Of Petitioner's Attorney(s) Name Of Respondent's/Decedent's Attorney(s) The clerk may order mediation using "Order Regarding Designation Of Mediator On Matter Before C lerk Of Superior Court" (AOC-G-301T). NOTE TO CLERK: AOC-G-300T, Side Two, New 3/06 © 2006 Administrative Office of the Courts CERTIFICATE OF SERVICE I, the undersigned, certify that I mailed by first class mail a copy of the Motion To Mediate to non-moving parties, interested persons, and fiduciarieseither designated by teh Clerk or identified by the petitioner in the pleadings. The address(es) given below is the last known address of the person(s) listed. Name And Address Of Person 1 Name And Address Of Person 2 Name And Address Of Person 3 Name And Address Of Person 4 Name And Address Of Person 5 Name And Address Of Person 6 Name And Address Of Person 7 Name And Address Of Person 8 Date SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Name Of Person/Entity Filing Motion Date Signature Signature Of Person/Entity Filing Motion Deputy CSC Notary Clerk Of Superior Court Assistant CSC SEAL Date My Commission Expires County Where Notarized