Free Certificate of Exemption (Civil & Family ADR) - South Carolina

STATE OF SOUTH CAROLINA

) ) COUNTY OF ________________________ ) ) ) ) Plaintiff, ) vs. ) ) ) Defendant. )

IN THE FAMILY COURT _____ JUDICIAL CIRCUIT

CERTIFICATE OF EXEMPTION

DOCKET NO. ___________________________

I certify that this action is exempt from mediation based on the following: This is a contempt action. This action involves issues of custody or visitation, but these issues were submitted to mediation with a certified mediator prior to filing this action. Other showing of exception circumstances: _____________________________________ Custody and visitation are not an issue in this action because there are no children. Custody and visitation are not contested in this action because the parties have agreed that custody shall be with ( Plaintiff/ Defendant) and that agreed visitation rights are as follows: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Date: Signature of Attorney for

SCRFCMFORM02 (3/2009)