Free Petition for Confidential Mediation Regarding Visitation (PR-E-LP-025) - California

PR-E-LP-025

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 GUARDIANSHIP OF THE PERSON ESTATE OF: (Name) , a Minor(s) Probate Case Number: PETITION FOR CONFIDENTIAL MEDIATION REGARDING VISITATION

1. A request for the court to order mediation has been requested by (petitioner) . (relationship to minor(s)) 2. CHILDREN AT ISSUE NAME DOB SCHOOL RESIDES WITH (Name & Address)

,

a.______________________________________________________________________________________ b.______________________________________________________________________________________ c.______________________________________________________________________________________

Name of Children(s) Attorney: (if applicable) Name:__________________________________ Street Address:___________________________ City/State/Zip:____________________________ Telephone Number:_______________________
3. Provide all requested names, mailing addresses, telephone numbers and attorney information of the

persons listed in attachment 3 to the best of your ability. Use business addresses only when the home address are unavailable.
MANDATORY PR-E-LP-025 (07.01.06 Petition For Confidential Mediation Regarding Visitation LOCAL RULE 15.89.01

PR-E-LP-025

4. A controversy exists between the below parties concerning visitation. (List parties name and relationship then provide a brief explanation): , (name) , (name) , (name) , (name) (relationship) (relationship) (relationship) (relationship)

__________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 5. Provide the following information regarding any other custody proceeding pending in the California court or any other court concerning the child to this proceeding: Name of the court, state, location, and case number:

6. Date of last Mediation Report. (If applicable): ________________ 7. Do you have a current Domestic Violence Restraining Order? Yes (If yes, attach a copy) No

8. Any information I have provided above and any attachment to this Petition are 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.

Dated: _____________

PRINT NAME

________________________________________ SIGNATURE OF PETITIONER

MANDATORY PR-E-LP-025 (07.01.06

Petition For Confidential Mediation Regarding Visitation LOCAL RULE 15.89.01

PR-E-LP-025

Mother's Information Name:___________________________________ DOB:____________________________________ Street Address:____________________________ City/State/Zip:_____________________________ Home Telephone Number:___________________ Work Telephone Number:____________________ Attorney Name:____________________________ Street Address:____________________________ City/State/Zip:_____________________________ Telephone Number:________________________ Petitioner(s) Information Name: ___________________________________ DOB:____________________________________ Street Address:____________________________ City/State/Zip:_____________________________ Home Telephone Number:___________________ Work Telephone Number:____________________ Attorney Name:____________________________ Street Address:____________________________ City/State/Zip:_____________________________ Telephone Number:_________________________ Legal Guardian(s) Information Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________ Other Person(s) Listed in Item #4 Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________

Father's Information Name: ___________________________________ DOB:____________________________________ Street Address:____________________________ City/State/Zip:_____________________________ Home Telephone Number:___________________ Work Telephone Number:____________________ Attorney Name:____________________________ Street Address:____________________________ City/State/Zip:_____________________________ Telephone Number:_________________________ Petitioner(s) Information Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________ Legal Guardian(s) Information Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________ Other Person(s) Listed in Item #4 Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________

ATTACHMENT 3

MANDATORY PR-E-LP-025 (07.01.06

Petition For Confidential Mediation Regarding Visitation LOCAL RULE 15.89.01

PR-E-LP-025

ORDER FOR MEDIATION
Mediation of the controversy is ordered: Mediation of the controversy is denied:

Dated: _____________

___________________________________________________ Judge of the Superior Court of California, County of Sacramento

MANDATORY PR-E-LP-025 (07.01.06

Petition For Confidential Mediation Regarding Visitation LOCAL RULE 15.89.01