ADR-111 Report of Referee
ADR-111
Form Approved for Op tion al Use
Judicial Council of California
ADR-111 [New January 1, 2006]
REPORT OF REFEREE
(Alternative Dispute Resolution)
Code of Civil Procedure, § 643
www.courtinfo.ca.gov
CASE NUMBER:
REPORT OF REFEREE
FOR COURT USE ONLY
REFEREE (Name, Stat e Bar number, if applicable, and address):
FAX NO. (Optional):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
TELEPHONE NO .:
E-MAIL ADDRESS (Optional):
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
a.
Total hours spent by referee:
b.
Total fees charged by referee:
Date. By order dated:
a.
Statutory authority. Referee was appointed under (check one):
b.
1.
Appointment. The undersigned refere e was appointed as follows:
(1)
Code of Civil Procedure section 638.
(2)
Code of Civil Procedure section 639.
2.
Submission. The hearing, if any, was concluded and the matter was submitted on (date):
3. Referee's time and fees. (All items must be completed if referee was appointed under section 639.)
4.
Recommendation on the merits. (State the recommendation on the merits of any disputed issues below or in Attachment 4.)
c.
Referee recommends the following allocation of payment of referee's fees (state the recommended allocation below or in
Attachment 3c):
(SIGNATURE OF REFEREE)(NAME OF REFEREE)
Date:
5.
Pages and attachments. Number of pages attached:
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