SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE BLYTHE 265 N. Broadway, Blythe, CA 92225 HEMET 880 n. State St., Hemet, CA 92543 CHILD CUSTODY EVALUATOR (Name and Address) INDIO 46-200 Oasis St., Indio, CA 92201 RIVERSIDE 4175 Main St., Riverside, CA 92501 RI-FL006 FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): FAX NO. (Optional): PETITIONER: CASE NUMBER: RESPONDENT: HEARING DATE: TIME: DEPARTMENT: CHILD CUSTODY EVALUATOR REPORT Attorney for Petitioner: Address: City: State: On the The focus of the evaluation was Child(ren)'s Full Name Attorney for Respondent: Address: City: State: ordered a Zip: Zip: . Evaluation pursuant to Family Code � . Date of birth Current age Gender Declaration Regarding the Process Followed On , the court ordered evaluation process was explained mother, and , the father. to , the 1. 2. 3. Summary of Current Orders Page 1 of 2 Approved for Optional Use Riverside Superior court RI-FL006 [Rev. 1//1] CHILD CUSTODY EVALUATOR REPORT Family Code � � 3111, 3118 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: New Developments INTERVIEWS AND INVESTIGATION: Parents Preference Regarding Child Custody and Visitation Alienation Home Visit and Observations Interview(s) with Child(ren) Collateral Reports Evaluator's Assessment Proposed Recommendations Respectfully submitted on : Name I declare under penalty of perjury under the laws of the State of California that the information above is true and correct Date: (TYPE OR PRINT NAME OF PARTY MAKING DECLARATION) (SIGNATURE) Page 2 of 2 Approved for Optional Use Riverside Superior court RI-FL006 [Rev. 1//1] CHILD CUSTODY EVALUATOR REPORT Family Code � � 3111, 3118 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com