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Petition For Private Mediation FL-E-LP-601 - California
| Petition For Private Mediation Form. This is a California form and can be used in Family Law Sacramento Local County . |
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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 CHILD CUSTODY RECOMMENDING COUNSELING 1. CASE NUMBER: Local Rules 14.08.01 Date of last Family Court Services Report: ______/__________/___________. Do you currently have an appointment with Family Court Services? If so, when? ______/_______/_________. 2. 3. Have you been to private child custody recommending counseling before? If so, when? ______/_______/_________. 4. 5. 6. Do you have a current Domestic Violence Restraining Order? Do you have an existing court order for custody/visitation? Yes (attach copy) Yes (attach copy) No No Issues to be mediated concern custody and visitation of the following named child(ren): ____________ _________________________________________________________________________________________ Request that one of the following private child custody recommending counselors be appointed: __________________________________________________________________________________________ 7. 8. Declarant shall advance the cost of private child custody recommending counseling 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 CHILD CUSTODY RECOMMENDING COUNSELING Parties agree that ________________________________________ (private child custody recommending counselor) 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: _______________ Date: _______________ Date: _______________ Date: _______________ __________________________________________, Petitioner __________________________________________, Respondent __________________________________________ Attorney for Petitioner __________________________________________ Attorney for Respondent Page 1 of 2 FL/E-LP-601 (Revised 12/11) Mandatory Petition for Private Child Custody Recommending Counseling Local Rule14.16.01 www.saccourt.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com 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. b. c. Date of deposit: Place of deposit (city and state): Addresses as follows: By personally delivering copies to the person served as follows: Person served (name): Address: Time: 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 12/11) Mandatory Petition for Private Child Custody Recommending Counseling Local Rule14.16.01 www.saccourt.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com
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