Free Petition for Confidential Mediation Packet - California

Superior Court of California, County of Sacramento Family Court Services

PETITION FOR CONFIDENTIAL MEDIATION PACKET
General Information Family Code Section 3170 requires mediation whenever issues of custody or visitation are in dispute. This applies whenever a "party to the case" wants to obtain or change a custody or visitation order and the other party does not agree to the change. A Petition for Confidential Mediation (local form FL/E- ME821) may be filed without an Order To Show Cause. Filing a Petition for Confidential Mediation is without prejudice to a party's right to future hearing. Confidential (non-recommending) mediation will be conducted by a Family Court Services Mediator who will facilitate negotiation between the parties to reach an agreement regarding custody and parenting issues. Mediation Report For mediations scheduled by filing of a Petition for Confidential Mediation, if the parties reach an agreement, Mediator will issue a written report specifying the agreement reached by the parties. However, if the parties are unable to reach an agreement the Mediator will not provide any written or verbal report. No recommendation will be submitted to Court. No information presented by the parties during confidential mediation will be reported or disclosed to anyone, except for the following situations. When child abuse or neglect is suspected by the Mediator, a report will be made to the Child Protective Services. Additionally, if a threat is made against a specific person during mediation, a law enforcement agency and the person against whom a threat was made will be contacted. Petition for Confidential Mediation Application Instructions Petition for Confidential Mediation form Case Demographics Sheet Proof of Service Form

Confidentiality

Contents of this Packet

4/10/2009 Page 1 of 2

Superior Court of California, County of Sacramento Family Court Services

PETITION FOR CONFIDENTIAL MEDIATION APPLICATION INSTRUCTIONS

Read the following instructions before completing the Petition for Confidential Mediation Form. 1. Type or print legibly in blue or black ink only. Please provide all information requested on the form. Incomplete forms will be returned for completion. 2. Provide petitioner's and respondent's name, mailing address and telephone number in section 6 & 7 of the petition. Use business addresses only when the home address is unavailable. If applicable, provide the name(s) and address(es) of the attorney(s) of record in section 6 & 7 and claimants information in section 8 of the petition. 3. Date and sign sections 5 of the petition and make three (3) photocopies. 4. Complete the attached Case Demographic Sheet. 5. Petition for Confidential Mediation must be served on the other party by another adult (not you or a person who is part of the case), by (a) personal service, by (b) facsimile with an additional copy mailed first class, or (c) first class mail. 6. The proof of service form (attached) must be completed. The only person who can sign the Proof of Service is the person who served the documents. 7. Submit the original and three (3) photocopies of the Petition for Confidential Mediation, Case Demographics Sheet, and a Proof of Service to Family Court Services, 3341 Power Inn Road, Room 104, Sacramento, CA 95826. Filings may also be placed in the court drop box located on the first (1st) floor. 8. Family Court Services will mail copies of the endorsed Petition for Confidential Mediation and Notice of Mediation Appointment with dates/times to all parties of the action. Mediation appointment cannot be re-set or dropped without the agreement of both parties. Both parties must contact Family Court Services, either by telephone or in writing, requesting or agreeing to the re-setting or dropping of the mediation appointment. Appointments are set only on weekdays. There are no evening appointments available.
4/10/2009 Page 2 of 2

FL/E-ME-811

Family Law Case Demographics Information Sheet for Child Custody/Visitation
Court Case Number: ____________________ Family Court Services Number: _____________________

Petitioner's Information
First Name Middle Initial Last Name First Name

Petitioner's Attorney Information

Middle Initial

Last Name

Street Number/Apt. or Suite #

Street Number/Apt. or Suite #

City

State

Zip Code

City

State

Zip Code

Date of Birth: Month Home Phone: Work Phone: Other Phone: ( ( ( ) ) ) Day Year Work Phone: Other Phone: ( ( ) )

Respondent's Information
First Name Middle Initial Last Name First Name

Respondent's Attorney Information

Middle Initial

Last Name

Street Number/Apt. or Suite #

Street Number/Apt. or Suite #

City Date of Birth: Month Home Phone: Work Phone: Other Phone: ( ( ( ) ) )

State

Zip Code

City

State

Zip Code

Day

Year Work Phone: Other Phone: ( ( ) )

FL/E-ME-811 (Revised 4/13/2009) Mandatory

Family Law Case Demographics Information Sheet

Page 1 of 3 Local Rule 14.08(C) (2) www.saccourt.ca.gov

FL/E-ME-811

Court Case Number: ____________________

Family Court Services Number: _____________________ Claimant's Attorney Information (Third Party)

Claimant's Information
First Name Middle Initial Last Name

First Name

Middle Initial

Last Name

Street Number/Apt. or Suite #

Street Number/Apt. or Suite #

City Date of Birth: Home Phone: Work Phone: Other Phone: Month ( ( ( ) ) )

State Day

Zip Code Year

City

State

Zip Code

Work Phone: Other Phone:

( (

) )

Claimant's Information
First Name Middle Initial Last Name

Claimant's Attorney Information (Third Party)

First Name

Middle Initial

Last Name

Street Number/Apt. or Suite #

Street Number/Apt. or Suite #

City Date of Birth: Home Phone: Work Phone: Other Phone: Month ( ( ( ) ) )

State Day

Zip Code Year

City

State

Zip Code

Work Phone: Other Phone:

( (

) )

Minor's Counsel Attorney Information First Name Middle Initial Last Name

Street Number/Apt. or Suite #

City

State

Zip Code

Work Phone: Other Phone:

( (

) )
Family Law Case Demographics Information Sheet Page 2 of 3 Local Rule 14.08(C) (2) www.saccourt.ca.gov

FL/E-ME-811 (Revised 4/13/2009) Mandatory

FL/E-ME-811

Court Case Number: ____________________

Family Court Services Number: _____________________

1.

List all children of the parties: Name Date of Birth Age School Resides with

2.

Please check all boxes that apply. a. Are you currently restrained by a Restraining Order or ever been restrained by a Restraining Order (domestic violence restraining order, emergency protective order, or criminal protective order)? b. Do you have a restraining order against the other party now(domestic violence restraining order, emergency protective order, or criminal protective order)? a. Number of previous mediation appointments:

Yes Yes

No No

3. None One Two Three

Four or more
No No No No

b. Do Petitioner/Respondent live 2-4 hours apart from each other? c. Do Petitioner/Respondent live more than 4 hours apart from each other? d. Is one or more of your children a Special Needs Child? e. Has there been past non-compliance with a Court Order? 4. a. b. c. d. e. f. g. 5. a. Are you or the other parent planning on moving out of the area? b. Does either parent pose a flight risk? Please note whether each or any of these issues are involved in your case: Custody Change Domestic Violence Substance Abuse Mental Health Current or Previous CPS Involvement Child Physical/Sexual Abuse Child Neglect

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes



No No No No No No No



Yes Yes

No No

FL/E-ME-811 (Revised 4/13/2009) Mandatory

Family Law Case Demographics Information Sheet

Page 3 of 3 Local Rule 14.08(C) (2) www.saccourt.ca.gov

FL/E-ME-803

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
PETITIONER: RESPONDENT:

FAMILY COURT SERVICES (FCS) PROOF OF SERVICE 1. 2. I am at least 18 years old and am not a party to this case. My residence or business address is:

Superior Court Case Number: FCS Case Number:

3.

I served a copy of the documents (specify each):

By enclosing them in a sealed envelope and depositing it with the United States Postal Service with the postage fully prepaid. The envelope was addressed and mailed as follows: a. Name of person served: b. Address: c. Date mailed: d. Place of mailing (city and state) By personally delivering copies to the person served, as follows: a. Name of person served: b. Date: c. Time: d. Address: 4. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. ________________________________________
(TYPE OR PRINT NAME)

________________________________________
(SIGNATURE OF PERSON WHO SERVED THE DOCUMENTS)

FL/E-ME-803 (Revised 4/13/2009) Mandatory

Family Court Services Proof of Service

Page 1 of 1 Local Rule 14.08 (C) (2), 14.08 (L) www.saccourt.ca.gov