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 PETITIONER: RESPONDENT: REQUEST FOR TELEPHONIC APPEARANCE (FAMILY LAW) TYPE OF HEARING: 1. I am the petitioner petitioner's counsel CASE NUMBER: DATE: respondent TIME: Other: DEPT: respondent's counsel ) 2. I request the court to allow me to appear from the following telephone number: ( 3. I request to appear telephonically for the following reason: . . . 4. I have filed this request at least five (5) court days prior to the hearing and will serve all parties/attorneys with this form within one (1) court day after filing the form. 5. I understand that the court, in its discretion, may decide to terminate the telephone appearance if it determines during the hearing that I am not available at the calendar call or delay due to disruption, noise, misconduct, a communication problem, a technical problem, or other issue. 6. I understand the court may decide at any time to require a personal appearance and continue the hearing. 7. I assume the risks of cost, time, delay, repeated telephone calls, technical failure, a wrong number, and/or other issues that may arise out of this telephone appearance. 8. I understand that except as provided in California Rules of Court, rule 1.150, court proceedings shall not be photographed, recorded, or broadcast. I have read the advisements of this form and Local Rules 30.14-30.17, and I understand that the terms apply to me. I declare under the penalty of perjury under the laws of the State of California that the foregoing is true and correct. DATE: _______________________________________ PRINTED NAME _______________________________________ SIGNATURE FOR COURT USE ONLY By Judicial Officer: The request is GRANTED DENIED _____________________________ Judicial Officer www.placer.courts.ca.gov Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com Date: ____________ Form Adopted for Mandatory Use Superior Court of California, County of Placer Form No. PL-FL016 Effective 01-01-2016