RI-PR013C RE IN THE MATTER OF: CASE NUMBER: PROBATE SUPERVISED VISITATION ORDER 1. Evidence has been presented in support of a request that the contact of Former guardian (name): Father Mother be supervised based upon allegations of abduction of child(ren) sexual abuse physical abuse domestic violence drug abuse alcohol abuse neglect other (specify): The Father Mother Former guardian disputes these allegations and the court reserves the findings on these issues pending further investigation and hearing or trial. 2. The court finds, under Family Code Section § 3100, that the best interest of the child(ren) requires that visitation by the ather Mother Former guardian must, until further order of the court, be limited to contact supervised by the person(s) set forth in item 6 below pending further investigation and hearing or trial. THE COURT MAKES THE FOLLOWING ORDERS 3. CHILD(REN) TO BE SUPERVISED Child s name Date of birth Age Sex 4. TYPE a. Supervised visitation b. Supervised exchange only c. Therapeutic visi ation 5. SUPERVISED VISITATION PROVIDER a. Professional (individual provider or supervised visitation center) b. Nonprofessional 6. AUTHORIZED PROVIDER Name Address Telephone Number Any other mutually agreed-upon third party as arranged. 7. 8. 9. DURATION AND FREQUENCY OF VISITS (see form RI-PR013 for specifics of visitation): PAYMENT RESPONSIBILITY Father: % Mother: % Former guardian % Party with visitation will contact professional provider or supervised visitation center no later than (date): 10. THE COURT FURTHER ORDERS Date: (JUDGE OF THE SUPERIOR COURT) Adopted for Optional Use Riverside Superior Court Form RI-PR013C [Rev. 01/01/12] PROBATE SUPERVISED VISITATION ORDER Page 1of 1 riverside.courts.ca.gov/localfrms/localfrms.shtml Attachment to Probate Visitation Order American LegalNet, Inc. www.FormsWorkFlow.com