Free MEDIATOR'S CERTIFICATE OF COMPLETION - New Jersey

Sample Form _____

UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY In re: Case No.

Chapter Debtor. Use adversary caption if applicable. Plaintiff, v. Defendant. Adversary No.

MEDIATOR'S CERTIFICATE OF COMPLETION OF MEDIATION CONFERENCE 1. I hereby certify that, pursuant to an order by this court dated _______________ referring this matter to the bankruptcy mediation program, a mediation conference(s):

9 was held on (list date(s) of conference(s)):
__________________________ __________________________ ___________________________ ___________________________

9 was not held.
2. A settlement resolution of this matter:

9 was reached

9 was not reached.

3. [If a settlement was reached:] The party designated to prepare the stipulation and proposed consent order to the court is _______________________________________________

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Mediator's Certificate of Completion Of Mediation Conference,Sample Form

(identify party by name). The stipulation and proposed consent order will be filed on or before

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Mediator's Certificate of Completion Of Mediation Conference,Sample Form

_____________________ (date).

Dated: __________________________

______________________________ Mediator's Signature Mediator's Name:________________________ Address: ______________________________ ______________________________ Telephone: ______________________________

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Mediator's Certificate of Completion Of Mediation Conference,Sample Form