EX-PARTE REQUEST AND ORDER RE: DISQUALIFICATION OF CCRC OR EVALUATOR Attorney or Party without Attorney Name: Street Address: Mailing Address: Cit y and Zip Code: Telephone No: Fax No: Attorney for: ( Name) FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF MERCED STREET ADDRESS: 2260 N Street MAILING ADDRESS: 627 W. 21 ST Street CITY AND ZIP CODE: Merced, CA 95340 Branch Name: Family Law Division PETITIONER: RESPONDENT: CLAIMANT: EX PARTE REQUEST AND ORDER RE: DISQUALIFICATION OF CCRC OR EVALUATOR Case Number: 1.) I am the Petitioner Respondent Other: in the action herei n. 2.) I move to disqualify to act as Child Custody Recommending Counselor (CCRC) or Evaluator in the matter herein for the following reasons: a.) Conflict of Interest. Please state all facts which support this claim. You may attach additional pages as needed. b.) Other. Please state all facts which support this claim. You may attach additional pages as needed. Date: PETITIONER/RESPONDENT/OTHER American LegalNet, Inc. www.FormsWorkFlow.com EX-PARTE REQUEST AND ORDER RE: DISQUALIFICATION OF CCRC OR EVALUATOR ORDER The Court hereby:Denies the Order requested: Grants the Order requested: It is so ordered.Dated:JUDGE/COMMISSIONER OF THE SUPERIOR COURT PROOF OF SERVICE BY MAIL OnI served the above Ex-Parte Request and Order Re: Disqualification orCCRC or Evaluator by depositing a copy thereof, enclosed in a sealed envelope with postage prepaid, in the United States mail, to the following parties and/or their attorney of record at the following addresses:At the time of service, I was at least 18 years of age and not a party to the action.My address is:I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and thisdeclaration is executed on in , California. Printed Name Signature American LegalNet, Inc. www.FormsWorkFlow.com