SUPERIOR COURT OF CALIFORNIA, COUNTY OF INYO FAMILY LAW MEDIATION REPORT CASE NUMBER: PETITIONER: RESPONDENT: MEDIATOR (Please type or print): Date of Mediation: Mediation did not occur for the following reason(s): Mediation session continued or re-scheduled to _________________________ Reason(s) for continuance (if different than above): Parties report no custody and/or visitation issues to resolve at this time. Mediation successful – Agreement and proposed Court Order attached. Mediation occurred and partial agreement was reached. Parties wish to litigate all issues Partial agreement and proposed Court Order attached. Remaining issues to be resolved: Appointment of minor’s counsel (Family Code § 3150) is indicated. Child Custody Evaluation (Family Code § 3111) is indicated. Date: ____________________________________ Signature of Mediator Family Law Mediation Report Form IC FL 107 (02-04-08); IC DV M107 (02-04-08) American LegalNet, Inc. www.FormsWorkflow.com