Guilford County District Court



|NORTH CAROLINA |IN THE GENERAL COURT OF JUSTICE |

| |DISTRICT COURT DIVISION |

|GUILFORD COUNTY | | File No. |______________ | |

| | |

|_______________________________ | |CONSENT STIPULATION |

| | |OF MEDIATOR |

| | |(FAMILY FINANCIAL CASE) |

| Plaintiff | |

| v. | |

|_______________________________ | | |

| Defendant | |

COMES NOW, the undersigned attorneys, or parties (if pro se) in this action, and do hereby stipulate and agree that the following mediator shall serve as the mediator in this family financial action:

|NAME: |______________________________________________ |

|ADDRESS |______________________________________________ |

| |______________________________________________ |

|PHONE NUMBER |______________________________________________ |

|FAX NUMBER |______________________________________________ |

| Certified Family Financial Mediator Non-Certified Family Financial Mediator |

The undersigned additionally hereby certify that the mediator named above has agreed to serve as mediator in this action and that a copy of this Stipulation has been served on the aforementioned mediator in accordance with Rule 5 of the North Carolina Rules of Civil Procedure.

|SIGNATURE | | |SIGNATURE | |

|NAME |____________________________ | |NAME |____________________________ |

|DATE |____________________________ | |DATE |____________________________ |

| Attorney for Plaintiff Plaintiff | | Attorney for Defendant Defendant |

|ADDRESS |____________________________ | |ADDRESS |____________________________ |

| |____________________________ | | |____________________________ |

|PHONE NO. |____________________________ | |PHONE NO. |____________________________ |

|EMAIL |____________________________ | |EMAIL |____________________________ |

Note to Mediator:

The mediator shall be responsible for reserving a place and making arrangements for the conference and giving timely notice to all attorneys and unrepresented parties of the time and location of the conference. The mediated settlement conference shall be completed by the completion deadline set forth in the Standing Order or in another Order entered by the presiding Judge and the mediator shall report the results of the conference to the Court within ten (10) days after the conference is completed or within ten (10) days of being advised by a party that the case settled or was otherwise disposed of prior to mediation.

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