ADR-111 - Report of Referee

Summary

Report of Referee

Text

Form ID: ADR-111
Title: Report of Referee
Effective Date: 2006-01-01
Mandatory Form: no
Info Page: https://selfhelp.courts.ca.gov/jcc-form/ADR-111
Primary Download URL: https://www.courts.ca.gov/documents/adr111.pdf
Form Detail Page:
Report of Referee
(ADR-111)
A referee appointed by the court gives the court recommendations on issues in the case that were assigned to the referee.
Get form ADR-111
Effective: January 1, 2006
PDF Text:
Form Approved for Optional Use 
Judicial Council of California 
ADR-111 [New January 1, 2006]
REPORT OF REFEREE 
(Alternative Dispute Resolution)
Code of Civil Procedure, § 643  
 
ADR-111
FOR COURT USE ONLY
CASE NUMBER:
REFEREE (Name, State Bar number, if applicable, and address):
         TELEPHONE NO.: FAX NO. (Optional):
         EMAIL ADDRESS (Optional):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
REPORT OF REFEREE
1. Appointment. The undersigned referee was appointed as follows:
a. Date. By order dated:
b. Statutory authority. Referee was appointed under (check one):
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.)
a. Total hours spent by referee:
b. Total fees charged by referee:
c. Referee recommends the following allocation of payment of referee's fees (state the recommended allocation below or in 
Attachment 3c):
4. Recommendation on the merits. (State the recommendation on the merits of any disputed issues below or in Attachment 4.)
5. Pages and attachments. Number of pages attached:
Date:
(NAME OF REFEREE)
 (SIGNATURE OF REFEREE)
Page 1 of 2

ADR-111 [New January 1, 2006] REPORT OF REFEREE 
(Alternative Dispute Resolution)
Page 2 of 2 
ADR-111
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
CASE NUMBER:
DECLARATION OF SERVICE OF REPORT OF REFEREE
1. I am at least 18 years of age, not a party to this action, and I am a resident of or employed in the county where the mailing took 
place.
2. My residence or business address is:
3. I served a copy of the Report of Referee (Alternative Dispute Resolution) (form ADR-111) by enclosing it in a sealed envelope 
with postage fully prepaid, as follows:
a. I deposited the sealed envelope with the United States Postal Service with the postage fully prepaid.
b. I placed the envelope for collection and processing for mailing following this business's ordinary practice with which I 
am readily familiar. On the same day that correspondence is placed for collection and mailing, it is deposited in the 
ordinary course of business with the United States Postal Service.
c. Date of deposit:
d. Place of deposit (city and state):
e. Addressed as follows (name and address of each party):
4. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME)
 (SIGNATURE OF DECLARANT)

Retrieval chunks

• #1

  Form ID: ADR-111 Title: Report of Referee Effective Date: 2006-01-01 Mandatory Form: no Info Page: https://selfhelp.courts.ca.gov/jcc-form/ADR-111 Primary Download URL: https://www.courts.ca.gov/documents/adr111.pdf Form Detail Page: Report of Referee (ADR-111) A referee appointed by the court gives the court…

• #2

  a. I deposited the sealed envelope with the United States Postal Service with the postage fully prepaid. b. I placed the envelope for collection and processing for mailing following this business's ordinary practice with which I am readily familiar. On the same day that correspondence is placed for collection and ma…