Form AOC-MED-ADR-14 "Request for Assignment of Retired Judge to Conduct Felony Mediation" - Kentucky

What Is Form AOC-MED-ADR-14?

This is a legal form that was released by the Kentucky Court of Justice - a government authority operating within Kentucky. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2021;
  • The latest edition provided by the Kentucky Court of Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form AOC-MED-ADR-14 by clicking the link below or browse more documents and templates provided by the Kentucky Court of Justice.

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AOC-MED-ADR-14
Doc Code: RFMP
Submit to:
Rev. 4-21
Felony Mediation Coordinator
Page 1 of 1
Administrative Office of the Courts
Commonwealth of Kentucky
1001 Vandalay Drive
Court of Justice
www.kycourts.gov
Frankfort, Kentucky 40601
REQUEST FOR ASSIGNMENT OF
RETIRED JUDGE TO CONDUCT
FelonyMediation@kycourts.net
FELONY MEDIATION
Requesting Judge: __________________________________________________
(Name)
__________________________________________________
(Title)
__________________________________________________
(Telephone No.)
1. (Check one): q I am requesting the Felony Mediation Program secure a mediator OR
q Retired Judge ________________________________ has agreed to conduct this mediation.
(Name)
2. I am requesting the mediation be held: (check one) q in person OR
q remote.
3. Reason(s) for Request: _________________________________________________________________________
____________________________________________________________________________________________.
4. Complete paragraph A if multiple cases are requested to be mediated on a specifi c date OR complete paragraph B if
one case is requested to be mediated.
q A. Mediation requested in ______________________ County on ________________________________.
(Name)
(Date)
Judicial Circuit Number/District Number: ________
OR
q B. Mediation requested in case ____________________________ in ______________________ County;
(Case Number)
(Name)
_____________________________________________________________________________________________________________.
(Case Name/Style)
_____________________________________________________________________
Commonwealth Attorney
:
(Name)
(Phone)
(Email)
Defense Attorney
__________________________________________________________________________
:
(Name)
(Phone)
(Email)
Type of Charge(s) to be mediated: ____________________________________________________________
________________________________________________________________________________________
Is the Defendant currently incarcerated? q Yes q No
If Yes, what facility: ____________________________
Victim Participation (check one): q Yes q No
5. Additional information which may assist in the selection of a Retired Judge: (attach additional pages if needed)
_____________________________________________________________________________________________
Date: _________________________, 2_______
______________________________________
Judge, ______ Judicial q Circuit q District
INTERNAL USE ONLY
q GRANTED: Retired Judge assigned: _______________________________________
q DENIED: Request denied as follows: ______________________________________________________________
____________________________________________________________________________________________
Date: __________________________________, 2______
Distribution: Court File Retired Judge Retired Judge Program Administrator Presiding Judge Felony Mediation Coordinator
Print
Reset Form
AOC-MED-ADR-14
Doc Code: RFMP
Submit to:
Rev. 4-21
Felony Mediation Coordinator
Page 1 of 1
Administrative Office of the Courts
Commonwealth of Kentucky
1001 Vandalay Drive
Court of Justice
www.kycourts.gov
Frankfort, Kentucky 40601
REQUEST FOR ASSIGNMENT OF
RETIRED JUDGE TO CONDUCT
FelonyMediation@kycourts.net
FELONY MEDIATION
Requesting Judge: __________________________________________________
(Name)
__________________________________________________
(Title)
__________________________________________________
(Telephone No.)
1. (Check one): q I am requesting the Felony Mediation Program secure a mediator OR
q Retired Judge ________________________________ has agreed to conduct this mediation.
(Name)
2. I am requesting the mediation be held: (check one) q in person OR
q remote.
3. Reason(s) for Request: _________________________________________________________________________
____________________________________________________________________________________________.
4. Complete paragraph A if multiple cases are requested to be mediated on a specifi c date OR complete paragraph B if
one case is requested to be mediated.
q A. Mediation requested in ______________________ County on ________________________________.
(Name)
(Date)
Judicial Circuit Number/District Number: ________
OR
q B. Mediation requested in case ____________________________ in ______________________ County;
(Case Number)
(Name)
_____________________________________________________________________________________________________________.
(Case Name/Style)
_____________________________________________________________________
Commonwealth Attorney
:
(Name)
(Phone)
(Email)
Defense Attorney
__________________________________________________________________________
:
(Name)
(Phone)
(Email)
Type of Charge(s) to be mediated: ____________________________________________________________
________________________________________________________________________________________
Is the Defendant currently incarcerated? q Yes q No
If Yes, what facility: ____________________________
Victim Participation (check one): q Yes q No
5. Additional information which may assist in the selection of a Retired Judge: (attach additional pages if needed)
_____________________________________________________________________________________________
Date: _________________________, 2_______
______________________________________
Judge, ______ Judicial q Circuit q District
INTERNAL USE ONLY
q GRANTED: Retired Judge assigned: _______________________________________
q DENIED: Request denied as follows: ______________________________________________________________
____________________________________________________________________________________________
Date: __________________________________, 2______
Distribution: Court File Retired Judge Retired Judge Program Administrator Presiding Judge Felony Mediation Coordinator
Print
Reset Form