Request for Mediation | GRAR | Greater Rochester Association of Realtors

Request for Mediation

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In the matter of

Complainant Name * Required

vs.

Respondent Name * Required

I am requesting mediation with the above-named disputant.

My claim is predicated upon the statement attached, marked Exhibit 1, and incorporated by reference into this application.

-> -> Attach your statement (Exhibit 1) - Must be a PDF or Word Document *

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Signature of Complainant / Authorized Designee * Required

Typed name serves as a signature

Date *

Street Address *

City *

State *

Zip *

Phone *

Email *