Order Of Referral To Mediation
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Order Of Referral To Mediation Form. This is a California form and can be use in Imperial Local County.
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Tags: Order Of Referral To Mediation, FL-02, California Local County, Imperial
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.:
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
FOR COURT USE ONLY
FAX NO. (Optional):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL
939 Main Street
El Centro, CA 92243
PETITIONER:
RESPONDENT:
ORDER OF REFERRAL TO MEDIATION
CASE NUMBER:
IT IS ORDERED; the parties are referred to mediation of the following issues with the Family
Court Mediator, located in the Access Center (Lower Level), 939 Main Street, El Centro, CA.
92243. Your appointment is set on : ________________ at _______ a.m./p.m.
(Date)
CUSTODY
LEGAL
Party Request:
(Time)
JOINT
SOLE
PHYSICAL
PETITIONER
RESPONDENT
VISITATION
Party Request:
ALTERNATE WEEKENDS EVERY WEEKEND WEEKDAYS
PETITIONER
SUMMER
HOLIDAYS OTHER SPECIFY
RESPONDENT
A hearing is set on ____________________ at ________
(Date)
a.m./p.m.
(Time)
in Department ____ of the Superior Court, 939 Main Street, El Centro, CA. 92243
_______________________
Date
___________________________________
Judge of the Superior Court
ORDER OF REFERRAL TO MEDIATION
Please provide the following information. Use Post Office Box if Domestic Violence is an
issue.
PETITIONER’S INFORMATION:
Name:
Address:
City State/Zip:
Home Phone:
Relationship to child:
Attorney’s name:
Address:
Language:
SIGNATURE
Work Phone:
RESPONDENT’S INFORMATION:
Name:
Address:
City State/Zip:
Home Phone:
Relationship to child:
Attorney’s name:
Address:
Language:
Work Phone:
SIGNATURE
If you need to reschedule please call 760-482-2240.
Form Approved for Mandatory Use FL-02 (Adopted 07/01/07, Revised 01/01/11)
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