ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL 939 W. Main Street El Centro, CA 92243 PETITIONER: RESPONDENT: OTHER PARENT: STIPULATION AND WAIVERS FOLLOWING MEDIATION; ORDER THEREON CASE NUMBER: After attending mediation on (date) ______________, the parties were able to reach a full agreement on contested custody and visitation issues, contained in the attached Mediation Agreement dated ______________. The parties declare and stipulate as follows: 1. We agree to comply with the terms set forth in the attached Mediation Agreement. Date: ______________ 2. Mediator: _______________________________ Each of us has knowledge of the hearing currently scheduled in this matter and waive our right to proceed with that hearing based upon the attached custody/visitation agreement reached between us. 3. The court has jurisdiction to make child custody orders in this case under the Uniform Child Custody Jurisdiction and Enforcement Act (part 3 of the California Family Code, commencing with section 3400) as California is the child(ren)'s home state. 4. 5. 6. Each of us had notice of the custody/visitation proceeding and were both given an opportunity to be heard. We agree the habitual place of residence of the child(ren) is the United States of America, County of Imperial. We acknowledge being advised that a violation of our custody/visitation agreement and this court order may subject us to civil or criminal penalties, or both. Date:_________________ Date:_________________ Date:_________________ ORDER ______________________________________ Signature of Petitioner ______________________________________ Signature of Respondent ______________________________________ Signature of Other Parent/Claimant FOR COURT USE ONLY Order to Show Cause/Notice of Motion hearing scheduled on __________ at _________ a.m. p.m. in Dept._____ is: VACATED. Custody and visitation are the only issues and have been resolved. REMAINS ON CALENDAR. There are additional issues to be resolved. Based upon the agreement of the parties, the Court adopts Mediation Agreement. Date:_________________ Mandatory Use FL-24 (Adopted 01/01/13, Revised 01/01/14) ______________________________________ Judge of the Superior Court STIPULATION AND WAIVERS FOLLOWING MEDIATION; ORDER THEREON American LegalNet, Inc. www.FormsWorkFlow.com