SUPERIOR COURT OF THE STATE OF CALIFORNIA, COUNTY OF PLACER ATTORNEY OR UNREPRESENTED PARTY (Name, State Bar Number, and Address): FOR COURT USE ONLY TELEPHONE NO.: EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): Superior Court of California, County of Placer 10820 Justice Center Drive P.O. Box 619072 Roseville, CA 95661-9072 Petitioner/Plaintiff: __________________________ Respondent/Defendant:________________________ Other Party: ________________________________ FAMILY LAW STIPULATION AND ORDER present present present not present not present not present CASE NUMBER: Parties have met and conferred on all issues herein STIP ORDER Disputed issues/child support calculation attached Continued to:____________________________________________________ Dept. _________ at _________ a.m. / p.m. Request of Petitioner/Respondent By stipulation. OSC to reissue Compliance review Issues for trial: _________________________________________________________________________________________ PARTIES WAIVE NOTICE PETITIONER RESPONDENT TO NOTICE Pending trial, or until further order of this Court, existing orders shall continue in effect except as modified by this order. Heard & Submitted Submitted upon receipt of brief(s) due:_______________ disputed issues/disso master attached Statement of Issues due:__________________________________________________ Stipulation of the parties entered pursuant to CCP Section 664.6 CHILD CUSTODY / VISITATION STIP ORDER Parties referred / re-referred to mediation / orientation. Court assigns ______________________________________________ Recommendation of mediator counsel for minor agreement: Other:_____________________________________ dated__________________ is adopted reviewed set for trial issue _____________________________________ Custody of minor children. Legal custody joint, or sole custody to Petitioner Respondent Physical custody joint, or sole custody to Petitioner Respondent Parenting time as follows: ________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Supervised visitation for Petitioner Respondent Supervision to be provided by Agency _________________________ Agreed Party __________________________ Costs for supervision to be paid for by Shared Petitioner Respondent Subject to reallocation Parties to exchange current address and telephone numbers _____________________________________________________________________________________________________________________________________________________________ Form Adopted for Optional Use www.placer.courts.ca.gov Superior Court of California, County of Placer Page 1 of 3 Form No. PL-FL012 Effective 01-01-2013 American LegalNet, Inc. www.FormsWorkFlow.com Each parent to be advised of medical emergency, hospitalization, health/dental/psychological, and school issues. Neither party to make disparaging remarks about the other parent. Neither party to discuss Court proceedings with child/ren Transportation to be shared provided by Petitioner Respondent Appointed as counsel for minor child/ren ___________________________________ 3110 investigation ordered denied full focused ______________ reviewed & adopted as modified 730 Evaluation ordered denied full focused ______________ reviewed & adopted as modified Costs of minor's counsel investigation evaluation to Petitioner Respondent shared subject to reallocation Both parties to be assessed for STEP program Minor child/ren's habitual residence is United States California has jurisdiction Child/ren may not be removed from the State of California County/ies of ____________________________________ SUPPORT STIP ORDER disputed issues/child support calculation attached Income and expense declarations to be filed by Petitioner Respondent support calculation attached Husbands gross income $________________ Wife's gross monthly income $_________________ Child Support Petitioner Respondent pays $_______per month effective _________ Court reserves jurisdiction Spousal Support Petitioner Respondent pays $_______per month effective _________ Court reserves jurisdiction Family Support Petitioner Respondent pays $_______per month effective _________ Court reserves jurisdiction Child support arrears in the amount of $________ Spousal support arrears in the amount of $____________ For the period of __________ through _________ payable at the rate of $__________ per month starting ____________________ Wage assignment to issue direct pay order until it takes effect Parties to notify each other of any changes in employment or income. Payable through DCSS pursuant to Family Code Section 4200 Petitioner Respondent ordered to pay ½ of work related child care costs directly to provider through wage assignment start date __________________ Uncovered medical/dental/vision/psychological expenses to be shared equally. Petitioner Respondent to provide health benefits for minors as is available from employment for children spouse PROPERTY ORDERS STIP ORDER Exclusive use of Exclusive use of residence other _____________________ to _________________________ to Petitioner Petitioner Respondent Respondent ATTORNEY FEES/COSTS STIP ORDER [ ] Parties have met and conferred on all issues herein Request of Petitioner Respondent is granted denied without prejudice reserved Petitioner Respondent shall pay to opposing party directly/on attorney account $____________ forthwith Pursuant to Code Section __________ and payable at the rate of $_______ each month due on the ___ of each month Commencing ___________________ OTHER ORDERS STIP ORDER _____________________________________________________________________________________________________________________________________________________________ Form Adopted for Optional Use www.placer.courts.ca.gov Superior Court of Califor