Form 5. IN THE SUPREME COURT OF THE STATE OF MONTANA

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