Free Completion of Mediation - New Jersey

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SUPERIOR COURT OF NEW JERSEY
, Plaintiff vs. __________________DIVISION __________________COUNTY DOCKET NO. __________________ CIVIL ACTION , Defendant COMPLETION OF MEDIATION FORM

Please complete and return to the court immediately after the mediation is concluded. Mediation Status: XM1 XM2 XM3 XM4 XM6 Case resolved Case resolved in part Case unresolved Case management order to be forwarded to court by plaintiff Settled prior to mediation

_____________________ Date Mediation Completed

_________________________________ Signature

________________________________ Mediator - please print or type name under signature

Revised 12/2007, CN 10827-English

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