MFL-148 ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS) TELEPHONE NO.: ATTORNEY FOR (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO UKIAH Courthouse, State and Perkins Streets 100 North State Street, Ukiah, CA 95482-0337 TEN MILE Branch Court 700 South Franklin Street, Fort Bragg, CA 95437 CASE NUMBER: PETITIONER: RESPONDENT: OTHER PARENT/CLAIMANT: HEARING DATE: REQUEST FOR TELEPHONIC APPEARANCE FOR FAMILY LAW MEDIATION (This notice must be filed with the court at least fifteen (15) court days before the appearance) TIME: DEPT.: Do not file this form for a court appearance; for a court appearance, you will need to file a separate request (form number MFL-146). 1. I, (name): am the petitioner/planitiff 2. 3. respondent/defendant other parent I ask the court to allow me to appear by telephone on my scheduled mediation date of I would like the Family Law Mediator to consider the following information in making it's decision whether to allow a telephonic appearance (check all that apply): a. b. c. d. e. f. g. I, or my witness, live or work outside of the state of California in (specify location): I live in County in California, which is courthouse where the mediation is set. I am disabled. I can not afford to travel to Ukiah or do not have reliable transportation. I will be incarcerated or confined in (specifiy): I am in the military and am currently stationed at (specify location: Other: miles from the above 4. I understand that the Family Law Mediator may need to contact me to discuss my application for telephonic participation in mediation. a. My contact information is (provide phone number): b. The best dates and times to reach me are at: If my request for telephone appearance for mediation is approved: a. I understand that mediation sessions are typically three (3) hours and that I must be available for the duration of the session. b. I understand that it is preferable that I have access to a land line telephone for the duration of the mediation session as mediation may be terminated if cellular phone reception is problematic. c. I am responsible for all costs and arrangements of the telephonic appearance. d. I must ensure that I have the use of a private area for the duration of the mediation session. e. I understand that no other individuals, including children, may be present for the duration of the mediation session. f. I understand that the Family Mediation Intake form (local form MFL-230) must be filled out and returned to the Family Law Mediator, either by fax or by mail, at least five (5) days in advance of the mediation session. Family Mediation Intake form: http://www.mendocino.courts.ca.gov/forms_and_filing/forms/MFL-230.pdf Fax Number: (707) 463-6874 Mail to: Carol Park, Family Law Mediator, 100 North State Street, Ukiah, CA 95482 5. I declare, under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME) (SIGNATURE) American LegalNet, Inc. www.FormsWorkFlow.com MFL-148 (rev 070116)