Free Petition for Confidential Mediation (FL/E-ME-804) - California

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 3/18/2009) Mandatory

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