SUPERIOR COURT OF CALIFORNIA COUNTY OF MERCED Family Law Division 2260 N Street Merced, CA 95340 Phone (209) 725-4117 Fax (209) 725-4118 JOHN D. KIRIHARA, Presiding Judge BRIAN L. McCABE, Assistant Presiding Judge CAROL ASH, Judge FRANK DOUGHERTY, Judge HUGH M. FLANAGAN, Judge MARC A. GARCIA, Judge RONALD W. HANSEN, Judge DAVID W. MORANDA, Judge DONALD J. PROIETTI, Judge RALPH J. COOK, Commissioner GERALD W. CORMAN, Commissioner HARRY L. JACOBS, Commissioner KATHLEEN GOETSCH, Court Executive Officer FORMAL REQUEST FOR SEPARATE MEDIATION CASE NAME: ____________________________ CASE NUMBER _____________________ I, ____________________________ submit this written request for the Family Law Court Services (FCS) Mediator to meet with parties separately and at separate times. Date: ___________________ ___________________________ Signature of Requesting Party American LegalNet, Inc. www.FormsWorkFlow.com