Superior Court of California, County of Contra Costa FOR COURT USE ONLY STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP: BRANCH NAME: PETITIONER / PLAINTIFF: RESPONDENT / DEFENDANT: CLAIMANT: ORDER RE APPOINTMENT OF COUNSEL FOR MINOR CASE NUMBER: 1. Today’s Date: Next Hearing Date: Time: Dept.: Judge (name): Temporary Judge Petitioner/Plaintiff present Attorney present (name): Respondent/Defendant present Attorney present (name): Claimant present Attorney present (name): Attorney for minor present (name): THE COURT FINDS: Pursuant to Family Code § 3150(a), it is in the best interest of the minor child to appoint private counsel to represent the interest of the child. 1. Name of counsel appointed for child: Name Address 2. Name of child for whom counsel appointed: Name Birth date Lives primarily with: Father Mother Telephone number Address Other: Name Telephone #: 3. Counsel is charged with all of the duties set forth in Family Code § 3151. 4. Counsel shall have all of the rights regarding the child as set forth in Family Code § 3151 and § 3152. In addition, counsel shall have access to police department records and/or files regarding the child and/or parties. 5. Compensation: Regular Rate Court Rate Hourly Rate $ _______ Other (e.g. flat fee) $________ retainer $_______ Reserved, parties to file Income & Expense Declaration in 20 days. ______% Petitioner, _____% Respondent 6. Counsel shall continue to represent the child unless relieved by the court, upon substitution of other counsel by the court, for cause, or until (date): __________________________. 7. The mediator and/or evaluator is authorized to speak with minor’s counsel unless either party files with the court a written objection within seven (7) days of the date of this order. A copy of the written objection shall be served on Family Court Services. Date: _____________ ______________________________________________ JUDGE / COMMISSIONER FAMLAW08/1-5-06 American LegalNet, Inc. www.FormsWorkFlow.com