COURT USE ONLY ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE Riverside Historic: 4050 Main Street, Riverside, CA 92501 Riverside Family Law: 4175 Main Street, Riverside, CA 92501 Hemet: 880 N State St., Hemet, CA 92543 Palm Springs: 3255 E. Tahquitz Canyon Way, Palm Springs, CA 92262 CASE NAME: CASE NUMBER: STIPULATION AND ORDER TO MEDIATION-PROBATE RETURN COURT DATE: The parties hereby stipulate that the following matters in this case shall be submitted to Mediation: All matters on calendar for the following date: The following matters (specify title of pleading and filing date): Mediator’s name and telephone number (if known): Date of Mediation Session (if known): OR Mediation to be completed by (date) The following parties shall attend and participate in the Mediation session: Original Signatures Type or print name of Party without attorney Attorney or Party without attorney (Signature) Party (Signature) Attorney or Party without attorney (Signature) Party (Signature) Attorney for Type or print name of Party Type or print name of Attorney for Party without attorney Type or print name of Party IT IS SO ORDERED: Date: Judge of the Superior Court of Riverside County Form# RI-P31 (4/5/2010) RI-P31 American LegalNet, Inc. www.FormsWorkFlow.com