FL/E-ME-810 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address): TELEPHONE NO.: For Court Use Only ATTORNEY FOR: (Name) SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO STREET ADDRESS: 3341 Power Inn Road CITY AND ZIP CODE: Sacramento, CA 95826 BRANCH NAME: William R. Ridgeway Family Relations Courthouse PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: MEDIATION RETURN AND NOTICE OF HEARING RE MEDIATION REPORT/RECOMMENDATION CASE NUMBER: 1. TO: (Name) 2. PLEASE TAKE NOTICE that a hearing on mediation report and recommendations in the above-entitled matter will be held at the time and place set forth below: DATE: 3. TIME: DEPARTMENT: [ ] Petitioner [ ] Respondent [ ] Claimant requests that the private mediation report be adopted: [ ] without change [ ] with the changes set forth in the Declaration 4. [ ] An OSC/NOM was filed with the petition for private mediation by ________________________ . The hearing will also cover these additional issues already pled: [ ] Spousal Support [ ] Attorney’s Fees/Costs [ ] Child Support [ ] Domestic Partner Support [ ] Other (specify): ____________ 5. Supporting Attachments: [ ] Completed Income and [ ] Declaration Expense Declaration [ ] Points and Authorities [ ] Other (Specify): _____________________ Notice: If you did not file an OSC or NOM with the Petition for Private Mediation, you may not use this form to obtain a hearing date following mediation. You must file an OSC or NOM. FL/E-ME-810 (Revised 1/01/2010) Mandatory Mediation Return and Notice of Hearing Re Mediation Page 1of 2 Local Rule 14.16 www.saccourt.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com FL/E-ME-810 CLERK’S CERTIFICATE OF MAILING I certify that I am not a party to this cause and that a copy of the Mediation Return and Notice of Hearing RE Mediation Report/Recommendation were sent to the person named in Item 1 by first class mail. The copies were enclosed in an envelope with postage fully prepaid. The envelope was addressed to the person named in Item 1, sealed, and deposited with the United States Postal Service at Sacramento, California, on (date): _______________________________ by____________________________________ Deputy Clerk. Petitioner’s Mailing Address Respondent’s Mailing Address [ ] [ ] [ ] [ ] FL/E-ME-810 (Revised 1/01/2010) Mandatory Mediation Return and Notice of Hearing Re Mediation Page 2of 2 Local Rule 14.16 www.saccourt.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com