ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address, Telephone & State Bar Number): Attorney for: (Name) Superior Court of California, County of Sacramento STREET ADDRESS: 3341 Power Inn Road MAILING ADDRESS: Same CITY & ZIP CODE: Sacramento, California 95826 GUARDIANSHIP OF THE PERSON ESTATE OF: (Name) , a Minor(s) Probate Case Number: PETITION FOR CONFIDENTIAL MEDIATION REGARDING VISITATION 1. A request for the court to order mediation has been requested by , (petitioner) . (relationship to minor(s)) 2. CHILDREN AT ISSUE NAME DOB SCHOOL RESIDES WITH (Name & Address) a.______________________________________________________________________________________ b.______________________________________________________________________________________ c.______________________________________________________________________________________ Name of Children(s) Attorney: (if applicable) Name:__________________________________ Street Address:___________________________ City/State/Zip:____________________________ Telephone Number:_______________________ 3. Provide all requested names, mailing addresses, telephone numbers and attorney information of the persons listed in attachment 3 to the best of your ability. Use business addresses only when the home address are unavailable. MANDATORY PR-E-LP-025 (07.01.06 Petition For Confidential mediation Regarding Visitation LOCAL RULE 15.89.01 American LegalNet, Inc. www.FormsWorkflow.com 4. A controversy exists between the below parties concerning visitation. (List parties name and relationship then provide a brief explanation): , (name) (relationship) , (name) (relationship) , (name) (relationship) , (name) (relationship) __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 5. Provide the following information regarding any other custody proceeding pending in the California court or any other court concerning the child to this proceeding: Name of the court, state, location, and case number: 6. Date of last Mediation Report. (If applicable): ________________ 7. Do you have a current Domestic Violence Restraining Order? Yes (If yes, attach a copy) No 8. Any information I have provided above and any attachment to this Petition are furnished in good faith in the hope of settling the controversy. I declare under penalty of perjury under the laws of the State of California that the foregoing information is true and correct. Dated: _____________ PRINT NAME MANDATORY PR-E-LP-025 (07.01.06 ________________________________________ SIGNATURE OF PETITIONER Petition For Confidential mediation Regarding Visitation LOCAL RULE 15.89.01 American LegalNet, Inc. www.FormsWorkflow.com Mother’s Information Name:___________________________________ DOB:____________________________________ Street Address:____________________________ City/State/Zip:_____________________________ Home Telephone Number:___________________ Work Telephone Number:____________________ Attorney Name:____________________________ Street Address:____________________________ City/State/Zip:_____________________________ Telephone Number:________________________ Father’s Information Name: ___________________________________ DOB:____________________________________ Street Address:____________________________ City/State/Zip:_____________________________ Home Telephone Number:___________________ Work Telephone Number:____________________ Attorney Name:____________________________ Street Address:____________________________ City/State/Zip:_____________________________ Telephone Number:_________________________ Petitioner(s) Information Name: ___________________________________ DOB:____________________________________ Street Address:____________________________ City/State/Zip:_____________________________ Home Telephone Number:___________________ Work Telephone Number:____________________ Attorney Name:____________________________ Street Address:____________________________ City/State/Zip:_____________________________ Telephone Number:_________________________ Petitioner(s) Information Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________ Legal Guardian(s) Information Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________ Legal Guardian(s) Information Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________ Other Person(s) Listed in Item #4 Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________ Other Person(s) Listed in Item #4 Name: ___________________________________ DOB:_____________________________________ Street Address:_____________________________ City/State/Zip:______________________________ Home Telephone Number:____________________ Work Telephone Number:_____________________ Attorney Name:_____________________________ Street Address:_____________________________ City/State/Zip:______________________________ Telephone Number:__________________________ ATTACHMENT 3 MANDATORY PR-E-LP-025 (07.01.06 Petition For Confidential mediation Regarding Visitation LOCAL RULE 15.89.01 American LegalNet, Inc. www.FormsWorkflow.com ORDER FOR MEDIATION Mediation of the controversy is ordered: Dated: _____________ MANDATORY PR-E-LP-025 (07.01.06 Mediation of the controversy is denied: ___________________________________________________ Judge of the Superior Court of California, County of Sacramento Petition For Confidential mediation Regarding Visitation LOCAL RULE 15.89.01 American LegalNet, Inc. www.FormsWorkflow.com