Superior Court of California, County of Sacramento Family Court Services PETITION FOR CONFIDENTIAL MEDIATION PACKET General Information Family Code Section 3170 requires mediation whenever issues of custody or visitation are in dispute. This applies whenever a "party to the case" wants to obtain or change a custody or visitation order and the other party does not agree to the change. A Petition for Confidential Mediation (local form FL/E- ME804) may be filed without an Order To Show Cause. Filing a Petition for Confidential Mediation is without prejudice to a party's right to future hearing. Confidential (non-recommending) mediation will be conducted by a Family Court Services Mediator who will facilitate negotiation between the parties to reach an agreement regarding custody and parenting issues. Mediation Report For mediations scheduled by filing of a Petition for Confidential Mediation, if the parties reach an agreement, Mediator will issue a written report specifying the agreement reached by the parties. However, if the parties are unable to reach an agreement the Mediator will not provide any written or verbal report. No recommendation will be submitted to Court. No information presented by the parties during confidential mediation will be reported or disclosed to anyone, except for the following situations. When child abuse or neglect is suspected by the Mediator, a report will be made to the Child Protective Services. Additionally, if a threat is made against a specific person during mediation, a law enforcement agency and the person against whom a threat was made will be contacted. Petition for Confidential Mediation Application Instructions Petition for Confidential Mediation form Case Demographics Sheet Proof of Service Form Confidentiality Contents of this Packet 7/6/2011 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Superior Court of California, County of Sacramento Family Court Services PETITION FOR CONFIDENTIAL MEDIATION APPLICATION INSTRUCTIONS Read the following instructions before completing the Petition for Confidential Mediation Form. 1. Type or print legibly in blue or black ink only. Please provide all information requested on the form. Incomplete forms will be returned for completion. 2. Provide petitioner's and respondent's name, mailing address and telephone number in section 6 & 7 of the petition. Use business addresses only when the home address is unavailable. If applicable, provide the name(s) and address(es) of the attorney(s) of record in section 6 & 7 and claimants information in section 8 of the petition. 3. Date and sign sections 5 of the petition and make three (3) photocopies. 4. Complete the attached Case Demographic Sheet. 5. Petition for Confidential Mediation must be served on the other party by another adult (not you or a person who is part of the case), by (a) personal service, by (b) facsimile with an additional copy mailed first class, or (c) first class mail. 6. The proof of service form (attached) must be completed. The only person who can sign the Proof of Service is the person who served the documents. 7. Submit the original and three (3) photocopies of the Petition for Confidential Mediation, Case Demographics Sheet, and a Proof of Service to Family Court Services, 3341 Power Inn Road, Room 104, Sacramento, CA 95826. Filings may also be placed in the court drop box located on the first (1st) floor. 8. Family Court Services will mail copies of the endorsed Petition for Confidential Mediation and Notice of Mediation Appointment with dates/times to all parties of the action. Mediation appointment cannot be re-set or dropped without the agreement of both parties. Both parties must contact Family Court Services, either by telephone or in writing, requesting or agreeing to the re-setting or dropping of the mediation appointment. Appointments are set only on weekdays. There are no evening appointments available. 7/6/2011 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com FL/E-ME-811 Family Law Case Demographics Information Sheet for Child Custody/Visitation Court Case Number: ____________________ Family Court Services Number: _____________________ Petitioner's Information First Name Middle Initial Last Name First Name Petitioner's Attorney Information Middle Initial Last Name Street Number/Apt. or Suite # Street Number/Apt. or Suite # City State Zip Code City State Zip Code Date of Birth: Month Home Phone: Work Phone: Other Phone: ( ( ( ) ) ) Day Year Work Phone: Other Phone: ( ( ) ) Respondent's Information First Name Middle Initial Last Name First Name Respondent's Attorney Information Middle Initial Last Name Street Number/Apt. or Suite # Street Number/Apt. or Suite # City Date of Birth: Month Home Phone: Work Phone: Other Phone: ( ( ( ) ) ) State Zip Code City State Zip Code Day Year Work Phone: Other Phone: ( ( ) ) FL/E-ME-811 (Revised 1/1/2010) Mandatory Family Law Case Demographics Information Sheet American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 3 Local Rule 14.16(C) (1), (2) www.saccourt.ca.gov FL/E-ME-811 Court Case Number: ____________________ Family Court Services Number: _____________________ Claimant's Attorney Information (Third Party) Claimant's Information First Name Middle Initial Last Name First Name Middle Initial Last Name Street Number/Apt. or Suite # Street Number/Apt. or Suite # City Date of Birth: Home Phone: Work Phone: Other Phone: Month ( ( ( ) ) ) State Day Zip Code Year City State Zip Code Work Phone: Other Phone: ( ( ) ) Claimant's Information First Name Middle Initial Last Name Claimant's Attorney Information (Third Party) First Name Middle Initial Last Name Street Number/Apt. or Suite # Street Number/Apt. or Suite # City Date of Birth: Home Phone: Work Phone: Other Phone: Month ( ( ( ) ) ) State Day Zip Code Year City State Zip Code Work Phone: Other Phone: ( ( ) ) Minor's Counsel Attorney Information First Name Middle Initial Last Name Street Number/Apt. or Suite # City State Zip Code Work Phone: Other Phone: ( ( ) ) Family Law Case Demographics Information Sheet American LegalNet, Inc. www.FormsWorkFlow.com FL/E-ME-811 (Revised 1/1/2010) Mandatory Page 2 of 3 Local Rule 14.16(C) (1), (2) www.saccourt.ca.gov FL/E-ME-811 Court Case Number: ____________________ Family Court Services Number: _____________________ 1. List all children of the parties: Name Date of Birth Age School Resides with 2. Please check all boxes that apply. a. Are you currently restrained by a Restraining