SUPERIOR COURT OF THE STATE OF CALIFORNIA, COUNTY OF PLACER ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number, and Address): FOR COURT USE ONLY TELEPHONE NO.: FAX NO.: EMAIL ADDRESS: SUPERIOR COURT OF CALIFORNIA, COUNTY OF PLACER 10820 Justice Center Drive 2501 N. Lake Blvd. P.O. Box 619072 P.O. Box 5669 Roseville, CA 95661-9072 Tahoe City, CA 96145 Fax to: (916) 408-6285 Fax to: (530) 584-3471 PETITIONER: RESPONDENT: REQUEST FOR ADDITIONAL FAMILY CENTERED CASE RESOLUTION STATUS CONFERENCE CASE NUMBER: TO THE CLERK OF THE COURT: I request that this case be set for a Status Conference. Below are 3 available dates (must be on a Tuesday for Roseville or Friday for Tahoe) for the Status Conference: 1. ____________________________________________________ 2. ____________________________________________________ 3. ____________________________________________________ DATE: ___________________ Signed: _______________________________________ Attorney Party FOR COURT USE ONLY Set for Status Conference: DATE: __________________ Time: __________________ DEPT. __________________ Notice mailed to ___________________________________________________ at address on file on: ________/________/20________ Submitting party was provided notice at the front counter on: ________/________/20________ ______________________________ Deputy Clerk Form Adopted for Optional Use Superior Court of California, County of Placer Form No. PL-FL019 Effective 01-01-2017 www.placer.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com