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UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF MISSOURI ____________DIVISION In re DEBTOR NAME, ) ) ) ) )

Case No.___-________-___ Chapter ___ REPORT OF MEDIATOR

Debtor(s).

The undersigned court-appointed mediator, reports to the Court as follows: ____ A. ____ B. A mediation conference was conducted on The conference resulted in the following: __________ Agreement signed (total resolution). The parties reached an impasse. The parties settled the following issues: (a) (b) (c) ____ C. The conference was continued and an additional mediation conference has be scheduled on: __________________________________________ The matter was settled prior to mediation conference.

____ D. Attendance:

Parties and Counsel present: Parties and Counsel not present: Dated:
Signature of Mediator Print Name Address City, State, Zip Code Telephone
(L.F. 24 Rev. 05/03)