In The

Court of Appeals

For The

First District of Texas

NO. 01–0___–__________–CV

_________________________, Appellant(s)

V.

_________________________, Appellee(s)

On Appeal from the __________ Court

__________ County, Texas

Trial Court Cause No. __________

NOTIFICATION TO MEDIATOR

As the mediator in this cause, you are responsible for ensuring that the attached "Appointment and Fee Report—Mediation" form is completed. The form must be filed with the Clerk of this Court no later than two days from the conclusion of the mediation.