Form 5

Mont. Code Ann. tit. 25, ch. 21, Form 5, under Appendix of Forms.

Mont. Code Ann. tit. 25, ch. 21, Form 5

IN THE SUPREME COURT OF THE STATE OF MONTANA Supreme Court Cause No.__________ _________________________________, Plaintiff/Petitioner and ☐ Appellant or ☐ Appellee, v.SELECTION OF MEDIATOR _________________________________, Defendant/Respondent and ☐ Appellant or ☐ Appellee. COME NOW the parties and advise that they have stipulated to and selected __________________________ as mediator for purposes of complying with the requirements of M. R. App. P. 7(4)(c). Dated this ___ day of __________, 20___. __________________________________ Attorney for Appellant __________________________________ Attorney for Appellee