Petition For Private Mediation Petition For Private Mediation - California by AmericanLegalNet

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									                                                                                                                   FL/E-LP-601
 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address):
 TELEPHONE NO:                                                                                For Court Use Only




  ATTORNEY FOR: (Name)
   SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO
   STREET ADDRESS: 3341 Power Inn Road
   MAILING ADDRESS: Same
   CITY AND ZIP CODE: Sacramento, CA 95826
   PETIT1ONER/PLAINTIFF:

   RESPONDENT/DEFENDANT:

                   PETITION FOR PRIVATE MEDIATION
                                  Local Rules 14.08.01                                    CASE NUMBER:
   1.     Date of last Mediation Report: ______/__________/___________.
   2.     Do you currently have an appointment set for FCS mediation? If so, when? ______/_______/_________.
   3.     Do you currently have an appointment set for FCS mediation? If so, when? ______/_______/_________.
   4.     Have you been to private mediation before? If so, when? ______/_______/_________.
   5.     Do you have a current Domestic Violence Restraining Order?                      Yes (attach copy)            No
   6.     Do you have an existing court order for custody/visitation?                     Yes (attach copy)          No
   7.     Issues to be mediated concern custody and visitation of the following named child(ren): ____________
          _________________________________________________________________________________________

   8.         Request that one of the following private mediators be appointed:
           __________________________________________________________________________________________

   9.       Declarant shall advance the cost of private mediation subject to the court reserving the right to
   order reimbursement from the other party.

     Any information I have provided above and any attachment to this Petition is furnished in good faith in the
hope of settling the controversy. I declare under penalty of perjury under the laws of the State of
California that the foregoing information is true and correct.

        Date: _____/________/________                      ___________________________________
                                                                  Signature of the Declarant
                          STIPULATION RE: PRIVATE MEDIATION

      Parties agree that ________________________________________ (private mediator) shall mediate issues
       Concerning custody and visitation of the following named children:
   ______________________________________
       _____________________________________________________________________________________________

      Parties stipulate to share all fares, _______% payable by Petitioner and ________% payable by
   Respondent.

   Date: _______________                                   __________________________________________, Petitioner

   Date: _______________                                   __________________________________________, Respondent

   Date: _______________                                   __________________________________________
                                                                     Attorney for Petitioner
   Date: _______________                                   __________________________________________
                                                                     Attorney for Respondent
                                                                                                                        Page 1 of 2
FL/E-LP-601 (Revised 12/2/2009)                          Petition for Private Mediation                         Local Rule14.16.01
Mandatory                                                                                                      www.saccourt.ca.gov

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                                                                                                      FL/E-LP-601



                            THE SUPERIOR COURT OF THE STATE OF CALIFORNIA

                                  IN AND FOR THE COUNTY OF SACRAMENTO




Petitioner _____________________________                    Case No. __________________


Respondent ___________________________                      PROOF OF SERVICE




1. I am over the age of 18 years and am not a party to this cause. I am a resident of or employed in the
   county where the mailing occurred. My residence or business address is:
   __________________________________________________________________
    __________________________________________________________________

2. I served a copy of the following document(s):
   __________________________________________________________________
    __________________________________________________________________




    By placing a true copy of each document in the United States mail in a sealed envelope with postage fully
    prepared as follows:

    a.   Date of deposit:
    b.   Place of deposit (city and state):
    c.   Addresses as follows:

    By personally delivering copies to the person served as follows:

    Person served (name):                                                            Time:

    Address:                                                                         Date:




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)




                                                                                                            Page 2 of 2
FL/E-LP-601 (Revised 12/2/2009)                 Petition for Private Mediation                     Local Rule14.16.01
Mandatory                                                                                         www.saccourt.ca.gov

                                                                                               American LegalNet, Inc.
                                                                                               www.FormsWorkFlow.com

								
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