Small Claims Court Mediation Agreement

Case Number

Plaintiff

Defendant

Date

Site

Type

Mediator(s)

Resolved

Yes

Not Resolved

AGREEMENTS EXPRESSED IN THIS MEDIATION AGREEMENT ARE SUBJECT TO COURT APPROVAL.

Both parties request that this case be continued without date. Please indicate the anticipated date upon which this agreement will be fulfilled:

The parties have entered into the following agreement. Plaintiff /Defendant agrees to pay $. as follows:

Additional Details:

3. When Defendant fully performs the terms of this agreement, it shall constitute a release by Plaintiff of the claims asserted in this case against Defendant. Plaintiff will so notify the court and will dismiss this case with prejudice. If Plaintiff does not fully perform the terms of this agreement, it is a breach of contract that could result in a separate damage claim by Defendant against Plaintiff.

4. If Defendant does not perform the terms of this agreement in full, Plaintiff may reopen the case and have it decided by the court on the original claim, less any payments made by Defendant under this agreement, or amend the claim to seek enforcement of this agreement. 5. Signing this form indicates that both parties accept the terms of this agreement.

5. Signing this form indicates that both parties accept the terms of this agreement.

Plaintiff/Date

Defendant/Date

Judge/Date

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Small Claims Court Mediation Agreement

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