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Request For Confidential Mediation PR-E-LP-025 - California
| Request For Confidential Mediation Form. This is a California form and can be used in Probate Sacramento Local County . |
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PR-E-LP-025 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address, Telephone & State Bar Number): Attorney for: (Name) Superior Court of California, County of Sacramento STREET ADDRESS: 3341 Power Inn Road MAILING ADDRESS: Same CITY & ZIP CODE: Sacramento, California 95826 GUARDIANSHIP OF THE PERSON ESTATE OF: (Name) , a Minor(s) Probate Case Number: REQUEST FOR CONFIDENTIAL MEDIATION REGARDING VISITATION 1. A request for the court to order mediation has been requested by (petitioner) . (relationship to minor(s)) 2. CHILDREN AT ISSUE NAME DOB SCHOOL RESIDES WITH (Name & Address) , a.______________________________________________________________________________________ b.______________________________________________________________________________________ c.______________________________________________________________________________________ Name of Children(s) Attorney: (if applicable) Name:__________________________________ Street Address:___________________________ City/State/Zip:____________________________ Telephone Number:_______________________ 3. Provide all requested names, mailing addresses, telephone numbers and attorney information of the persons listed in attachment 3 to the best of your ability. Use business addresses only when the home address are unavailable. PR-E-LP-025 (Revised 1/1/2013) Mandatory Request for Confidential Mediation Regarding Visitation Page 1 of 4 Local Rule 4.33 www.saccourt.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com PR-E-LP-025 4. A controversy exists between the below parties concerning visitation. (List parties name and relationship then provide a brief explanation): , (name) , (name) , (name) , (name) (relationship) (relationship) (relationship) (relationship) __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 5. Provide the following information regarding any other custody proceeding pending in the California court or any other court concerning the child to this proceeding: Name of the court, state, location, and case number: 6. Date of last Mediation Report. (If applicable): ________________ 7. Do you have a current Domestic Violence Restraining Order? Yes (If yes, attach a copy) No 8. Any information I have provided above and any attachment to this Petition are 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. Dated: _____________ PRINT NAME PR-E-LP-025 (Revised 1/1/2013) Mandatory ________________________________________ SIGNATURE OF PETITIONER Request for Confidential Mediation Regarding Visitation Page 2 of 4 Local Rule 4.33 www.saccourt.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com PR-E-LP-025 ATTACHMENT 3 Mother's Information Name:___________________________________ DOB:____________________________________ Street Address:____________________________ City/State/Zip:_____________________________ Home Telephone Number:___________________ Work Telephone Number:____________________ Attorney Name:____________________________ Street Address:____________________________ City/State/Zip:_____________________________ Telephone Number:________________________ Petitioner(s) Information Name: ___________________________________ DOB:____________________________________ Street Address:____________________________ City/State/Zip:_____________________________ Home Telephone Number:___________________ Work Telephone Number:____________________ Attorney Name:____________________________ Street Address:____________________________ City/State/Zip:_____________________________ Telephone Number:_________________________ Legal Guardian(s) Information Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________ Other Person(s) Listed in Item #4 Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________ Father's Information Name: ___________________________________ DOB:____________________________________ Street Address:____________________________ City/State/Zip:_____________________________ Home Telephone Number:___________________ Work Telephone Number:____________________ Attorney Name:____________________________ Street Address:____________________________ City/State/Zip:_____________________________ Telephone Number:_________________________ Petitioner(s) Information Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________ Legal Guardian(s) Information Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________ Other Person(s) Listed in Item #4 Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home
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