Office of Dispute Resolution

SEVENTH JUDICIAL ADMINISTRATIVE DISTRICT

P.O. BOX 963 PHONE: (770) 387-4820

CARTERSVILLE, GA 30120 TOLL FREE: (877) 655-6865

www.7jad.com FAX: (770) 387-5479

PDF VERSION

Attorney Referral Form

Date: ____________________

Case Number: _________-CV- ____________________ County: _________________________

_________________________________v. __________________________________

ATTN: ADR Office

Please note that the above-referenced case has not been referred to mediation by the Seventh Judicial Administrative District ADR Office. We feel that this case is appropriate for mediation. The information your office needs to make the final determination is listed below:

1. The defendant(s) resides in the state of Georgia YES NO

2. The defendant(s) have been served YES NO __________

^{Service Date}

3. What type of case is this? General Civil ______________________

^Description

Domestic Relations ______________________

^Description

__________

^{Answer Date}

4. Is there any violence alleged in this case? YES NO

5. If yes, has a TPO been filed? YES NO

6. PLAINTIFF’S DATA DEFENDANT’S DATA

Name: (Last, First MI) Name: (Last, First MI)

Mail Address Mail Address

City, State and Zip City, State and Zip

Phone Phone

Attorney’s Name Attorney’s Name

City, State and Zip City, State and Zip

Phone / Fax Phone / Fax

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Signature (Required) __________________________ Name (Printed) __________________________________