Free Mediation - Assignment to BDR Program (Request) - Hawaii

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UNITED STATES BANKRUPTCY COURT DISTRICT OF HAWAII In re ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) Case No. Chapter

Debtor(s). ____________________________________ [if Adversary Proceeding]

Adversary Proceeding No. [if Adversary Proceeding]

Plaintiff(s), vs.

Defendant(s). ____________________________________

REQUEST FOR ASSIGNMENT TO BDR PROGRAM Request is hereby made by the parties signing below ("Parties") that the matter described herein be assigned to the BDR Program established under LBR 9019-2 and the Guidelines for Bankruptcy Alternative Dispute Resolution ("BDR Guidelines"). In support of this request, the following information is provided: 1. The disputed matter to be assigned is:

G the above-entitled adversary proceeding or G a contested matter entitled:_____________________________________________________.
2. Trial or a dispositive motion is set for hearing on: ______________________. 3. The Parties request that discovery be stayed until: ______________________. 4. The debtor-in-possession or trustee, on behalf of the bankruptcy estate, and not individually, is a party to this matter:
LBF 9019-2req 3/20/01

G Yes

G No.

5. The Parties have read the BDR Guidelines and agree to comply with all procedural requirements:

G Yes G Yes

G No. G No.

6. The Parties agree to the provisions in the BDR Guidelines concerning confidentiality:

7. The Parties agree that the mediator will not be acting as an attorney for any party and that the mediator will be deemed to be performing quasi-judicial functions and shall be entitled to all privileges, immunities and protections that applicable law accords to persons serving in such capacity:

G Yes

G No.

8. In the event that the dispute is not resolved after the mediator's initial review of the matter and the first 4 hours of BDR conference time, the Parties agree that they will either: (1) conclude the BDR process or (2) pay for the mediator's services at the mediator's regular hourly rate:

G Yes

G No.

9. The Parties suggest as mediator the following: ________________________ _____________________________________________________________________________.

Party: __________________ Represented by: ______________________ Signature Name: _______________________ Address: _______________________ _______________________ Phone/Fax: _______________________

______________ Date

Party: __________________ Represented by: _____________________ Signature Name: _______________________ Address: _______________________ _______________________ Phone/Fax: _______________________

______________ Date

[Attach additional signature pages if more than 2 parties.] 2

LBF 9019-2req

3/20/01