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IN THE CIRCUIT COURT FOR THE

EIGHTEENTH JUDICIAL CIRCUIT


IN AND FOR SEMINOLE COUNTY, FLORIDA

_____________________________

Plaintiff, CASE NO: _________________________


vs.

_____________________________

_____________________________

_____________________________

Defendants.
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MEDIATION SETTLEMENT AGREEMENT


(SHORT FORM)

The above styled cause was mediated on this _____ day of ___________, 200__.

An agreement was reached and as to the parties joining in this document the agreement is:

______ 1. A full and complete settlement agreement

______ 2. A partial Settlement with issues reserved for trial

______ 3. A temporary settlement with all issues reserved except as stated herein.

The parties joining in this agreement:

1. Plaintiff’s representative____________________________________

2. Plaintiff’s counsel ________________________________________

3. Defendant______________________________________________

4. Defendant______________________________________________

5. Defendant______________________________________________

6. Defendant______________________________________________

1
The following parties were in attendance at mediation and do not join in this agreement:

1. _________________________________________________________

2. _________________________________________________________

3. _________________________________________________________

4. _________________________________________________________

The terms of the agreement are as follows:

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2
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Dated ________________________________

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(Print name and party identification) _________________________________________

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(Print name and party identification) _________________________________________

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(Print name and party identification) _________________________________________

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(Print name and party identification) _________________________________________

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(Print name and party identification) _________________________________________

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(Print name and party identification) _________________________________________

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3
(Print name and party identification) _________________________________________

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(Print name and party identification) _________________________________________

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(Print name and party identification) _________________________________________

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(Print name and party identification) _________________________________________

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(Print name and party identification) _________________________________________