PR-E-LP-025 Page 1 of 2 PR-E-LP-025 PETITION FOR CONFIDENTIAL MEDIATION Local Rule 4.33 (Rev 09/25/2017) www.saccourt.ca.gov Mandatory ATTORNEY, OR PARTY IF NO ATTORNEY: State Bar No.: Name: Address: City/State/Zip: TELEPHONE NO.: ATTORNEY FOR: (Name) For Court Use Only SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO STREET ADDRESS: 3341 Power Inn Road MAILING ADDRESS: Same CITY, STATE, AND ZIP CODE: Sacramento, CA 95826 GUARDIANSHIP OF THE PERSON ESTATE OF: (Name) , a Minor(s) PETITION FOR CONFIDENTIAL MEDIATION Case No.: 1. This request for Confidential Mediation has been made by , (Petitioner) . (Relationship to minor(s)) 2. Do you have a current Restraining or Protective Order against the Guardian(s), or one that expired within the past 5 years? No Yes (If yes, you are not eligible for Confidential Mediation) 3. Children at Issue: (attach additional page if needed) FULL NAME DOB 1) 2) 3) Children(s) Attorney: (if applicable) Name: Telephone Number: Address: I declare under penalty of perjury under the laws of the State of California that the foregoing information is true and correct. Dated: (Print Full Name) SIGNATURE OF PETITIONER American LegalNet, Inc. www.FormsWorkFlow.com PR-E-LP-025 Page 2 of 2 PR-E-LP-025 PETITION FOR CONFIDENTIAL MEDIATION Local Rule 4.33 (Rev 09/25/2017) www.saccourt.ca.gov Mandatory DEMOGRAPHIC INFORMATION PROOF OF SERVICE BY MAIL 1. I am at least 18 years old, am not a party to this case, and I am a resident of or employed in the county where service was completed. 2. I served a copy of this document by enclosing it in a sealed envelope and depositing it with the U.S. Postal Service with the postage fully prepaid. The envelope was addressed and mailed as follows: Name of person(s) served: Address: Date mailed: Place of mailing (city and state): I declare under penalty of perjury that the information above is true and correct. Dated: // Signature of Person Doing the Serving: Type or Print Name: Mother222s Information Name: DOB: Street Address: City/State/Zip: Telephone Number: Attorney Name: Street Address: City/State/Zip: Telephone Number: Father222s Information Name: DOB: Street Address: City/State/Zip: Telephone Number: Attorney Name: Street Address: City/State/Zip: Telephone Number: Legal Guardian(s) Information Name: DOB: Street Address: City/State/Zip: Telephone Number: Attorney Name: Street Address: City/State/Zip: Telephone Number: Legal Guardian(s) Information Name: DOB: Street Address: City/State/Zip: Telephone Number: Attorney Name: Street Address: City/State/Zip: Telephone Number: American LegalNet, Inc. www.FormsWorkFlow.com