ADR-111State (JC)Fillable

Report of Referee

Judicial Council of California · Civil

Verified current as of August 1, 2026

This form allows a referee (a neutral person appointed by the court) to report the results of a mediation or arbitration proceeding back to the court. Attorneys, mediators, and parties involved in civil disputes use this form to document whether a settlement was reached or what recommendations the referee is making to help resolve the case.

This form has fillable fields — you can complete it directly in the viewer on the right.
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