ATTORNEY OR PARTY WITHOUT ATTORNEY FOR COURT USE ONLY Name: Street Address: Mailing Address: City and Zip Code: Telephone Number: ATTORNEY FOR (Name) SUPERIOR COURT OF CALIFORNIA, COUNTY OF EL DORADO 495 Main Street, Placerville CA 95667 1354 Johnson Blvd., South Lake Tahoe CA 96150 CASE NUMBER REQUEST FOR TELEPHONIC APPEARANCE CHILD CUSTODY RECOMMENDING COUNSELING (CCRC) I, _______________________________________, request the Court's approval to appear for the CCRC scheduled for ______________________ by telephonic appearance. I will call the following number the day of the appointment: (530) 621-6726 for appointments before 1:00PM in Placerville. (530) 621-6725 for appointments after 1:00PM in Placerville. (530) 573-3075 for all South Lake Tahoe appointments. I am requesting to participate by telephone for the following reasons: I live more than 120 miles away from the courthouse location for the appointment. I have a medical issue that restricts travel (Physician's note attached). Other (please explain): _______________________________________________________________________ _______________________________________________________________ If granted, I will be in a private place with no other persons present, where I can fully participate without disruption, including no children, friends or attorney listening to the call or providing me with advice using any other means of media. Date: _____________________ ___________________________________________ Signature of Party DENIED The request for Telephonic CCRC is hereby: GRANTED Date: ___________________ ______________________________________________ Judge of the Superior Court Provided a copy to party or Attorney/Message to Party: _______________________________________________ (Date) (Court Clerk's Initials) Local Form F-102 Mandatory Use New 08/17/15 Request for Child Custody Recommending Counseling Telephonic Appearance American LegalNet, Inc. www.FormsWorkFlow.com