STATE OF SOUTH CAROLINA	)	IN THE COURT OF COMMON PLEAS
)
COUNTY OF	)
)	PROOF OF ADR OR EXEMPTION
)
Plaintiff,	)
)
vs.	)
FILE NO.:
)
)
Defendant.	)
)
(An original and copy of this form is to be completed and filed with the Office of the Clerk of Court and a copy forwarded to the attorneys for the parties within 10 days of the conclusion of ADR, or within 300 days of the filing date of the action, whichever is earlier.)
PURSUANT to the South Carolina Alternative Dispute Resolution Rules (SCADR):
A.	I certify that this case is exempt from ADR for the following reason and the
parties wish to exercise that exemption:

Plaintiff/Attorney for Plaintiff
Defendant/Attorney for Defendant

Print Name
Print Name

Phone/Fax
Phone/Fax
Date:
B.	1.	Alternative Dispute Resolution (ADR) was conducted in the form of:

(Note:	If binding arbitration has been chosen by the parties but not yet
completed, an appropriate order of dismissal must be attached hereto.)

2.

The neutral(s) was/were: (Name of arbitrator/mediator):

3.

The ADR was conducted on

, 20

SCADR 104A (11/2012)

4.

As a result of ADR, this case should be considered (please check one);

( )

Fully Settled.

( )

by Consent Judgment, to be filed by

or

( )

Voluntary Dismissal to be filed by

( )

Partially Settled.

( )

At an Impasse.

( )

In need of further ADR I am am not willing to continue as a neutral. I recommend that ADR resume as
of	.
5.	Plaintiff
was present
was not present
Defendant
was present
was not present
6.	Other partcipants were:

Lawyer for Defendant
Lawyer for Plaintiff
Representative for Insurance Carrier
Guardian ad Litem
Experts
Others
7.	Choice of the neutral was by:

Stipulation
Court Order

8.

The total number of hours spent in ADR was:

hours.
9.	Further comments of the neutral:

Neutral’s Signature

Date:

SCADR 104B (11/2012)

STATE OF SOUTH CAROLINA

tblack

2012-11-27

Radeker, Adriane L.

South Carolina Judicial Department