25-21-2005: Form 5

Form 5

IN THE SUPREME COURT OF THE STATE OF MONTANA

Supreme Court Cause No.__________

_________________________________,

Plaintiff/Petitioner and

☐ Appellant or ☐ Appellee,

v.SELECTION OF MEDIATOR

_________________________________,

Defendant/Respondent and

☐ Appellant or ☐ Appellee.

COME NOW the parties and advise that they have stipulated to and selected __________________________ as mediator for purposes of complying with the requirements of M. R. App. P. 7(4)(c).

Dated this ___ day of __________, 20___.

__________________________________

Attorney for Appellant

__________________________________

Attorney for Appellee