District Court Denver Juvenile Court ________________________________ County, Colorado Court Address:

In re: The Marriage of: Parental Responsibilities concerning: ______________________________________________________ Petitioner/Plaintiff(s): and Co-Petitioner/Respondent/Defendant(s): Attorney or Party Without Attorney (Name and Address):

COURT USE ONLY Case Number:

Phone Number: FAX Number:

E-mail: Atty. Reg. #:

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 s/he is the victim of physical or psychological abuse by the other party. Mediation or ADR is not appropriate in this case because: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

______________________________________
Petitioner/Plaintiff Date

_____________________________________________
Co-Petitioner/Respondent/Defendant Date

______________________________________
Petitioner/Plaintiff's Attorney Signature, if any

_____________________________________________
Co-Petitioner/Respondent/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 (Civil Case) 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 R9/08

MOTION RE: EXEMPTION FROM MEDIATION/ADR ORDER (CIVIL CASE)