IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT DILLINGHAM
In the Matter of the Protective Proceeding of ) ) ) ) ) )
Respondent/Ward or Protected Person
CASE NO.3DL -
REQUEST FOR COURT SPONSORED GUARDIANSHIP MEDIATION I am requesting a referral to the court sponsored guardianship mediation program. I am: Respondent/Ward (or attorney) Petitioner (or attorney) Court Visitor GAL Guardian or Conservator person is Other (family, domestic partner, etc.) and my relationship to the .
In order to make the best plan, I think the following people should participate in the mediation: NOTE: If you need to add more names, please attach an additional sheet. Name Relationship Phone(s) & E-mail Address Phone
I think mediation should focus on the following areas or issues of concern:
Date I certify that on a copy of this request was sent to: Respondent's Atty. Petitioner`s Atty. Mediator Court Visitor GAL Dispute Resolution Coordinator, Karen Largent Other
By:
Signature Type or Print Name Mailing Address City State ZIP
Contact Telephone Number(s)
MED-100 DILLINGHAM (07/07) REQUEST FOR COURT SPONSORED GUARDIANSHIP MEDIATION