Free Mediator Selection Form - New Hampshire

UNITED STATES DISTRICT COURT DISTRICT OF NEW HAMPSHIRE

v.

Civil No. _______________

NOTICE OF SELECTED MEDIATORS­TO BE FILED CONVENTIONALLY

The following is submitted on behalf of all parties to the case. The parties have [agreed to/been ordered to] mediate this case. Pursuant to LR 53.1(c), the parties have jointly selected five (5) possible mediators from the court's approved list in descending order of preference, which is set forth below. Mediator #1 Mediator #2 Mediator #3 Mediator #4 Mediator #5 _______________________________ _______________________________ _______________________________ _______________________________ _______________________________

Date:
Name of Filer Bar No. Law Firm Name Address City, State, Zip Code Phone: (xxx) xxx-xxxx

CERTIFICATE OF SERVICE I hereby certify that this Notice was served conventionally on the following persons on this date and in the manner specified herein: Date:
Name of Filer Bar No. Law Firm Name Address City, State, Zip Code Phone: (xxx) xxx-xxxx