STATE OF SOUTH CAROLINA	)	IN THE FAMILY COURT
)	JUDICIAL CIRCUIT
COUNTY OF	)
)
)
Plaintiff,	)	REQUEST FOR APPOINTMENT
)	OF MEDIATOR
)
vs.	)	__________-DR - ______- __________
)
)
Defendant.	)
)	Case File Date:

Plaintiff/Attorney for Plaintiff:

Office Address:

Telephone:

Email Address:

SC Bar #:

Defendant/Attorney for Defendant:

Office Address:

Telephone:

Email Address:

SC Bar #:

Pursuant to Rule 4(d)(2)(C) of the South Carolina Alternative Dispute Resolution Rules (SCADR), I hereby request that the Clerk of Court appoint a primary mediator and a secondary mediator for this action utilizing the process prescribed for in Rule 4(d)(2)(B), SC ADR.

Mediator requested by:
Attorney for Plaintiff Attorney for Defendant
Pro se Litigant

____________________________________

Attorney or Pro Se Litigant Signature

Date: _________________

SCADR 109 (05/2015)

STATE OF SOUTH CAROLINA

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2015-04-15

Radeker, Adriane L.

South Carolina Judicial Department