Attorney or Party without Attorney ( Name, Address and Telephone number) For Court Use Only SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO STREET ADDRESS MAILING ADDRESS CITY AND ZIP CODE BRANCH NAME Plaintiff(s): Defendant(s): PETITION FOR CONCILIATION CASE NUMBER: To the Conciliation Court: Name of Petitioner or Petitioner(s) Allege . . . as follows: (a) That a controversy exists between the parents herein, and request the aid of said Court to effect a reconciliation or an amiable settlement of the controversy. (b) That the name and age of each minor child whose welfare may be affected by the said controversy is as follows: Name: Age: Name: Age: Name: Age: Name: Age: (c) That the name and address of each petitioner is as follows: Name: Address: Name: Address: Name: Address: Name: Address: (d) That the (husband) (wife) of the petitioner is: Name: Address: Telephone Number: ; and that said (husband) (wife) is named as respondent. (e) That whose address is has a relation to said controversy within the meaning of Section 1763, Code of Civil Procedure, (Statues 1939, Chap. 737) and is hereby also named as respondent herein. Dated: by: PETITION FOR CONCILIATION 16-6477-356 Rev. 04-2014 American LegalNet, Inc. www.FormsWorkFlow.com