Provided a copy to party or Attorney/Message to Party: (Date) by (Court Cle Attorney or Party without Attorney Name: Street Address: Mailing Address: City 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. 21ST Street CITY AND ZIP CODE: Merced, CA 95340 Branch Name/Location: Family Law Division, CCRC-FCS Offices REQUEST FOR TELEPHONIC CHILD CUSTODY RECOMMENDING COUNSELING (CCRC) Case Number: I, , request he CCRC scheduled for by a telephonic appearance. I understand that if granted, I will be contacted and given notice of the possible six (6) hour time period in which the CCRC will be held. The telephone number provided below is the number where I can be reached throughout that time period. I am requesting to participate by telephone for the following reasons: I, , submit that this is a true and correct telephone number of where I can be reached for the purpose of Court contact and CCRC: Telephone number including area code Date: Signature of Party The request for Telephonic Mediation is hereby: GRANTED DENIED Date: Ju American LegalNet, Inc. www.FormsWorkFlow.com