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TELEPHONE NO:
ATTORNEY FOR (name):
FAX NO:
Defendant:/ Respondent:
Case Number
That
Address:
City, State, Zip:
Phone Number:
It is understood that the ADR Information Form must be submitted by the parties and counsel at the conclusion of the case.
Attorney(s) signing on behalf of their client(s) have been given the authority to stipulate to mediation.
___________________
___________________________________
___________________________________
Date
___________________
___________________________________
___________________________________
Date
___________________
___________________________________
___________________________________
Date
___________________
___________________________________
___________________________________
Date
APPROVED:
DATED:
_____________________________________
JUDGE OF THE SUPERIOR COURT
________________________________________________________________________________________________________________________________________________________________________________________
STIPULATION AND ORDER TO PARTICIPATE IN ADR
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LOCAL CIV6 (Effective 7/1/03) OPTIONAL FORM