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Before you call the mediation office please complete the following form. This will
expedite your case.
Are you the Petitioner
Or the Respondentif you are unsure refer to the Order for Mediation
Gross annual incomeThis is your income before any taxes or other decutions are taken out.
Gross annual income If known.
County your case is filed:
Case Number Look on the Order for Mediation if unknown.
Do you and the party in question have attorneys?
If the answer to the question about was next please fill out the following information:
Your attorneys name
Your attorneys phone
Other attorneys name
Other attorneys phone
Has there ever been domestic violence between you and the other party?
Do you and the party in question have children together?
Childs name Childs birthdate Childs age Female
Has either you or the other party gone to the Department of Revenue for help with child support?
If the answer to the question above is yes then please tell us when:
Is DOR representing the case: Yes No
Is there any thing else you would like us to know:
You will then be contacted with some possible dates for the mediation either by phone or letter. Our office will then coordinate a date with the other party.