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. __________

PARTIES' NOTIFICATION TO COURT OF MEDIATOR

The parties have agreed that the following person will mediate this cause:

Mediator's name: _________________________________________

State Bar of Texas identification number: _______________________

Mailing address: __________________________________________

__________________________________________

__________________________________________

Telephone number: ________________________________________

Fax number: ______________________________________________

e-mail address: _____________________________________________

_________________________________

Attorney's name:

State Bar of Texas identification number:

Mailing address:

Telephone number:

Fax number:

e-mail address:

Counsel for:

_________________________________

Attorney's name:

State Bar of Texas identification number:

Mailing address:

Telephone number:

Fax number:

e-mail address:

Counsel for:

_________________________________

Attorney's name:

State Bar of Texas identification number:

Mailing address:

Telephone number:

Fax number:

e-mail address:

Counsel for: