ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FL/E-LP-601 FOR COURT USE ONLY TELEPHONE NO: ATTORNEY FOR: (Name) SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO STREET ADDRESS: 3341 Power Inn Road MAILING ADDRESS: Same CITY AND ZIP CODE: Sacramento, CA 95826 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: PETITION FOR PRIVATE CHILD CUSTODY RECOMMENDING COUNSELING 1. CASE NUMBER: A Request for Order re: child custody and /or child visitation is set for hearing on ______________, at ____________, in department __________. Have you been to mediation before? Yes No If yes, mediation was provided by Family Court Services and/or Private Child Custody Recommending Counselor. What is the date of the most recent mediation held? _______________. Do you currently have an appointment with Family Court Services? If so, what is the date and time? ____________ at __________. Yes No 2. 3. 4. List the names and ages of the children for whom custody and/or visitation is sought: ______________________________ _______________________________ ______________________________ _______________________________ ______________________________ _______________________________ I request that one of the following Private Child Custody Recommending Counselors be appointed: ____________________________ _______________________________ 5. NOTICE: A Declaration of Private Child Custody Recommending Counselor Regarding Qualifications, local form (FL/E/FR-411), must be attached for each recommending counselor proposed. Declarant shall advance the cost of Private Child Custody Recommending Counseling subject to the court reserving the right to order reimbursement from the other party. I declare under penalty of perjury under the laws of the State of California that the foregoing information is true and correct. Date: _____________ ______________________________ Signature of the Declarant __________________________________________________________________________________ Form Adopted for Mandatory Use Local Form FL/E/LP-601 Revised 11/25/13 PETITION FOR PRIVATE CHILD CUSTODY RECOMMENDING COUNSELING Local Rule 5.18 www.saccourt.ca.gov Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com STIPULATION RE: PRIVATE CHILD CUSTODY RECOMMENDING COUNSELING Parties agree that ________________________________ (Private Child Custody Recommending Counselor) shall mediate issues concerning custody and/or visitation of the children identified in section #4 above. Parties stipulate to allocate all fees, ____________% payable by Petitioner and __________% payable by Respondent. Date: ___________ ________________________________________ Petitioner ________________________________________ Respondent ________________________________________ Attorney for Petitioner _________________________________________ Attorney for Respondent Date: ___________ Date: ___________ Date:___________ PROOF OF PERSONAL SERVICE 1. I am at least 18 years old, not a party to this action, and not a protected person listed in any of the orders. 2. Person served (name): 3. I served copies of the following documents (specify): Petition for Private Child Custody Recommending Counseling Response to the Petition for Private Child Custody Recommending Counseling _________________________________________ 4. By personally delivering copies to the person served, as follows: a. Date: __________ b. Time: ______________ c. Address: _________________________________________________ 5. I am not a registered California process server. d. exempt from registration under Business a. a registered California process server. Code section 22350(b). b. an employee or independent contractor of a e. a California sheriff or marshal. c. Registered California process server. 6. My name, address, and telephone number and, if applicable, county of registration and number (specify): I declare under penalty of perjury under the law of the State of California that the foregoing is true and 7. correct. 8. Date: _________________________________________________ PRINT NAME OF PERSON WHO SERVED THE PAPERS __________________________________________________ SIGNATURE OF PERSON WHO SERVED THE PAPERS I am a California sheriff or marshal and I certify that the foregoing is true and correct. __________________________________________________________________________________ Form Adopted for Mandatory Use Local Form FL/E/LP-601 Revised 11/25/13 PETITION FOR PRIVATE CHILD CUSTODY RECOMMENDING COUNSELING Local Rule 5.18 www.saccourt.ca.gov Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com