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Petition For Confidential Mediation FL-E-ME-804 - California
| Petition For Confidential Mediation Form. This is a California form and can be used in Family Law Sacramento Local County . |
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FL/E-ME-804 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address): NO.: TELEPHONE 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, California 95826 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: CLAIMANT: PETITION FOR CONFIDENTAL MEDIATION Family Code §§ 3160-3186 FL Case No.:___________________________ FCS Case No.:_________________________ 1. Provide any of the following applicable case numbers: Family Law: Domestic Violence: ____________________ ____________________ Family Support: Other Family Law# ____________________ ____________________ 2. A Controversy exists between the above named parties concerning (check all that apply and provide brief explanation): Custody Visitation Other ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 3. 4. Date of last Mediation Report: __________/__________/__________ Do you have a current Domestic Violence Restraining Order? Yes (If yes, attach a copy) No 5. 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 that the foregoing information is true and correct. Dated: _______/_______/_______ SIGNATURE OF DECLARANT Mediation of the controversy is ordered: Dated: _______/_______/________ Judge of the Superior Court of California, County of Sacramento Mediation of the controversy is denied: (See Attached form) FL/E-ME-804 (Revised 1/1/2010) Mandatory Page 1of 1 Petition for Confidential Mediation Family Code §§ 3160-3186 Local Rule 14.16(C) (2) C:\Documents and Settings\florese\Local Settings\Temporary Internet www.saccourt.ca.gov Files\OLKE8\Form Petition for Confidential Mediation.doc American LegalNet, Inc. www.FormsWorkFlow.com
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