Motion To Waive Mediation Iowa Court Forms

Order #5

IN THE IOWA DISTRICT COURT IN AND FOR ___________________ COUNTY

____________________________________,

No.: _______________

Petitioner,

MOTION TO WAIVE MEDIATION

and

___________________________________,

Respondent

:

I request that the court waive the order for mediation in this case for the following reasons

1.____ I am a protected party in a currently valid domestic abuse protective order or no-contact order

issued in a civil or criminal case. A copy of the order is attached to this application. (If an order is not

attached, provide the name of the case, case number, county in which the order is issued, the date of

issuance):_____________________________________________________________________________

_____________________________________________________________________________________

2._____ There is a history of domestic abuse, as defined in Iowa Code Section 598.41(3)(j) (for example,

previous filings for protective orders by me, violations of protective orders or no-contact orders by the

other party, police response to domestic abuse calls, or domestic abuse assault convictions or arrests of

the other party.) Because of that history I believe I am in danger of physical or emotional abuse in

connection with a mediation session. Describe history of domestic abuse:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

3.______ I seek a waiver of mediation for other reasons (set forth reasons):

_____________________________________________________________________________________

_____________________________________________________________________________________

4. My name________________

Other party/attorney’s name___________________________

Address:

_______________

Address:________________________

__________________

__________________________

__________________

_________________________

_______(check here) I CERTIFY THAT THE STATEMENTS IN THIS MOTION ARE TRUE AND

CORRECT, AND I HAVE MAILED A COPY OF THIS MOTION TO THE OTHER PARTY’S

ATTORNEY OR TO THE OTHER PARTY IF UNREPRESENTED BY AN ATTORNEY

_______________________________________

Signature of Attorney or Party Filing Motion if

unrepresented by an Attorney

MOOT/comments:   T o   w aive   m ediation                                                                                                       R evised   9 /11