Order and Referral to Family Mediation
Case No:
B. Payment must be made by cash, money order, check or Master Card/Visa credit card to the Clerk of the
Courts, at each of the courthouse locations.
C. No family mediation session will be held for any party who fails to make the required payment
unless the party has been found indigent or excused from payment.
D. If the parties have a combined annual income of less than $50,000, each of the parties shall pay the sum
of $60.00.
E. If the parties have a combined annual income greater than $50,000 but less than $100,000.00, each of
the parties shall pay the sum of $120.00.
F. If a party has been found to be indigent, that party shall bring a copy of the Determination of Indigence
Status or appropriate court order to the ADR office, in which case the fee will be waived for that party.
G. If the parties have a combined annual income greater than $100,000.00, parties must utilize private
mediation. Please refer to paragraph 4 of this order for additional instructions.
3. Both parties shall complete and file a notarized Family Law Financial Affidavit with the Clerk of the
Courts at least 10 days prior to mediation. Each party shall bring to mediation a copy of their filed
Family Law Financial Affidavit AND proof of all income and expenses, including but not limited to,
paycheck stubs, income tax return for the most recent year, W-2 forms or 1099 forms, medical
expenses, child care and any other related documents.
4. Either party may file a motion with the Clerk of the Courts to cancel Mediation, in the event the
parties have a combined annual income of over $100,000. The Form Motion can be obtained from the
Self Help Center or the Court’s Website. If needed, this motion must be filed with the Clerk of the
Courts, along with notarized Family Law Financial Affidavit Forms for both parties, providing a copy
to all parties involved in the case.
5. If a Final Judgment of Injunction for Protection against Domestic or Repeat Violence has been
entered or a Domestic Violence or Repeat Violence case is pending that prohibits contact between the
parties, parties shall inform the ADR Program, so accommodations may be made. A Family
Mediation Questionnaire is attached for your convenience. Please complete this Questionnaire and
return it in the self-addressed stamped envelope as soon as possible.
6. If the case is settled prior to mediation, parties MUST file with the Clerk of the Courts, the settlement
agreement along with Parenting Plan and Child Support Guidelines Worksheet, if the case involves minor
children. Parties MUST file the appropriate motion to cancel mediation with the Clerk of the Courts, no
later than seven (7) full business days prior to mediation. Failure to do so will result in imposition of fees
against one or both of the parties. The party who failed to appear shall pay the required fee of $60.00 or
$120.00 to the Clerk of the Court within 15 days of the filing of the mediator’s report. If both parties fail to
appear, each shall pay the $60.00 or $120.00 to the Clerk of the Court within 15 days of the filing of the
mediators report.
