FL/E-lP-603 FOR COURT USE ONLY ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address, State Bar Number) ATTORNEY FOR: (NAME) SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: PETITIONER/PLAINTIFF: CASE NUMBER: RESPONDENT/DEFENDANT: ORDER FOR PRIVATE MEDIATION 1. _________________________________________is hereby appointed and designated by this Court to mediate issues concerning custody and visitation of the following named child(ren): ____________________________________________________________________________________________________ 2. Said mediator shall have all the duties and responsibilities as set forth in Chapter 11, Articles 1, 2, and 3, section 3160 et seq. of the Family Code, as set forth in Item 5. 3. Said mediator shall, pursuant to Family Code section 3183, and consistent with local court rules, submit a recommendation to the court as to the custody of or visitation with the child(ren). 4. Payment of fees for mediation services including preparation of a report shall be as follows: (check one) a. _______________________________________________ to pay all fees subject to the court reserving the right to order reimbursement from the other part. b. Parties to share all fees, _________% payable by Petitioner and __________% payable by Respondent. c. ___________________________________________________________________________________________. 5. Said mediator shall have access to pertinent information obtained by (1) Child Protective Services pursuant to the confidentiality policy of the Juvenile Court Presiding Judge; and/or (2) Family Court Services in prior mediation(s) with the parties, regarding the above-named child(ren) and shall keep such information confidential. 6. Said mediator shall now or in the future confer, upon request, with the following individuals: (1) any courtappointed private and/or Family Court Services mediators; (2) any court-appointed custody evaluator; and/or (3) any court-appointed attorney for the minor child(ren). 7. Mediation will be performed in accordance with the provisions of Family Code sections 3177, 3178(a), 3180, 3181(a), 3182, 3183, 3184, and 3185(a). 8. Said mediator is expressly authorized to have ex parte communication with counsel for the minor(s) before a recommendation is made pursuant to Family Code section 216. IT IS SO ORDERED: The Response to the Petition for Private Mediation was considered. No response was filed. Dated: ______________________ FL/E-LP-603 (Revised 4/7/2009) Mandatory _______________________________________________________ JUDGE OF THE SUPERIOR COURT Order for Private Mediation Page 1 of 1 Local Rule 14.08.01 www.saccourt.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com