CANB — Adversary Proceeding No._________________

Source: https://www.canb.uscourts.gov/sites/default/files/forms/adrcertification.pdf

UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF CALIFORNIA

In Re: ) ) ______________) Debtor ) Bankruptcy No. ) _____________) Plaintiff ) ) vs. ) Adversary Proceeding No. ) ______________________________) ADR CERTIFICATION Defendant

Pursuant to B.L.R. 9040-3, each of the undersigned certifies that he or she has read the

Bankruptcy Dispute Resolution Program Information Sheet, discussed the available dispute

resolution options provided by the court, reviewed dispute resolution options offered by private

entities, and considered whether this matter might benefit from any of them.

Dated: [Type name of plaintiff or cross plaintiff under the signature.]

Dated: [Type name of counsel for plaintiff or cross plaintiff, and the name of the party counsel represents, under the signature.]

Dated: [Type name of defendant or cross defendant under the signature.]

Dated: [Type name of counsel for defendant or cross defendant, and the name of the party counsel represents, under the signature.]

Note: This ADR Certification shall be served by the plaintiff on all defendants and must be signed by each party and its counsel. If there is more than one plaintiff, the plaintiff listed first in the caption of the adversary proceeding shall also serve this ADR Certification on all other plaintiffs. If there are additional parties (e.g., additional plaintiffs, defendants, cross plaintiffs, or cross defendants), additional sheets should be filed.