Free LOCAL FORMS - California


File Size: 18.7 kB
Pages: 1
Date: February 10, 2009
File Format: PDF
State: California
Category: Court Forms - Local
Author: jacortez
Word Count: 180 Words, 1,690 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.imperial.courts.ca.gov/Forms/FL-05.pdf

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Superior Court of California, County of Imperial ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE

FOR COURT USE ONLY

ATTORNEY FOR (NAME):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL
STREET ADDRESS: MAILING ADDRESS:: CITY AND ZIP CODE:

PETITIONER/PLANTIFF: RESPONDENT/DEFENDANT: CLAIMANT:

ADVANCE MEDIATION FORM Family Code ยงยง 3160-3186

Case No.:

1.

Provide any of the following applicable case numbers: Family Law: _________________ Family Support: ________________ Domestic Violence: _____________ Other Family Law # _____________

2.

A Controversy exists between the above names parties concerning (check all that apply and provide brief explanation): Custody Visitation Other ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

3. Date of last Mediation Report: ________/ ________/ __________ 4. Do you have a current Domestic Violence Restraining Orders? Yes (If yes, attach a copy) No 5. Any information I have provided above and any attachment to this Petition is furnished is good faith in the hope of settling the controversy. I declare under penalty of perjury that the foregoing information is true and correct. Dated: ______/______/_____ _____________________________ Dated: _____/______/______ _____________________________

ORDER: Mediation of the controversy is ordered. Dated: _____/____/_____
Form Approved for Optional Use FL-05 (Adopted 7/1/07; Revised 7/1/08)

_________________________________________ Judge of the Superior Court of California, County of Imperial