CV-E-MED-170 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number, and Address) State Bar No. FOR COURT USE ONLY TELEPHONE NO. EMAIL ADDRESS (Optional) FAX NO. (OPTIONAL) SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO th STREET ADDRESS: 720 9 Street, Room 102 th MAILING ADDRESS: 720 9 Street, Room 102 CITY AND ZIP CODE: Sacramento, CA 95814 BRANCH NAME: Gordon D. Schaber PLAINTIFF: DEFENDANT: SETTLEMENT CONFERENCE DATE: DECLARATION AND REQUEST FOR EXEMPTION FROM MANDATORY SETTLEMENT CONFERENCE PROGRAM (Local Rule 2.80) CASE NUMBER: Having participated in Mediation pursuant to Local Rule 2.74, the following party requests that the above-entitled matter be exempted from the Mandatory Settlement Conference Program: REQUESTING PARTY TYPE/NAME: _____________________________________________________________________ DATE OF MEDIATION: ________________________________________________________________________________ TYPE OF MEDIATION: Court Mediation Private Mediation MEDIATOR: _________________________________________________________________________________________ ORDER The foregoing Declaration having been read and considered, and good cause appearing: The Court vacates the scheduled Mandatory Settlement Conference. The Court orders that no Mandatory Settlement Conference shall be scheduled in this matter. Request for exemption from the Mandatory Settlement Conference Program is denied. It is further ordered that: ________________________________________________________________________________ _____________________________________________________________________________________________________ Dated: ______________________________ Signed: __________________________________________________________ Judge of the Superior Court CV-E-MED-170 (Revised June 17, 2013) MANDATORY DECLARATION AND REQUEST FOR EXEMPTION FROM MANDATORY SETTLEMENT CONFERENCE (LOCAL RULE 2.80) CIVIL Page 1 of 1 Local Rule 2.80 www.saccourt.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com