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In The Court of Appeals For The First District of Texas

NO. 01-___-______-CV

______, Appellant(s)

V.

______, Appellee(s)

On Appeal from the ______Court ______County, Texas Trial Court Cause No. ______

MEDIATOR’S REPORT

The Court referred this cause to mediation.

______served as mediator in this appeal based on the agreement of the parties. After the referral to mediation, the cause:

 settled before the mediation was conducted.

 settled during mediation.

 did not settle.

Check one of the following:

 Based on the agreement of the parties and the mediator, the mediator has been paid a fee as follows:

$______paid by

______.

$______paid by

______.

$______paid by

______.

$______paid by

______.

 The parties ask the Court to tax this fee as a cost of the

appeal.

 The parties have agreed to another method of payment and

understand that the Court will not tax this fee as a cost of

2 appeal.

______Mediator’s name: State Bar of Texas identification number: Mailing address: Telephone number: Fax number:

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