Attorney or Party without Attorney ( Name, Address and Telephone number) APPEARING FOR PLAINTIFF DEFENDANT For Court Use Only IN PRO PER SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO Barstow District: 235 E Mt View Ave, Barstow, CA 92311 Big Bear District: 477 Summit Blvd, Big Bear Lake, CA 92315 (Mailing address use Victorville District) Joshua Tree District: 6527 White Feather Road, Joshua Tree, CA 92252 Needles District: 1111 Bailey Ave, Needles, CA 92363 Rancho Cucamonga District: 8303 Haven Ave, Rancho Cucamonga, CA 91730 San Bernardino Family Law Division: 351 N. Arrowhead Ave, San Bernardino, CA 92415-0240 Victorville District: 14455 Civic Drive Ste 100, Victorville, CA 92392 Plaintiff(s): Defendant(s): PETITION FOR CONCILIATION CASE NUMBER: To the Conciliation Court: Name of Petitioner or Petitioner(s) Allege . . . as follows: (a) That a controversy exists between the parents herein, and request. . . the aid of said Court to effect a reconciliation or an amiable settlement of the controversy. (b) That the name and age of each minor child whose welfare may be affected by the said controversy is as follows: Name: Age: Name: Age: Name: Age: Name: Age: (c) That the name and address of each petitioner is as follows: Name: Address: Name: Address: Name: Address: Name: Address: (d) That the (husband) (wife) of the petitioner is: Name: Address: Telephone Number: ; and that said (husband) (wife) is named as respondent. (e) That whose address is has a relation to said controversy within the meaning of Section 1763, Code of Civil Procedure, (Statues 1939, Chap.. 737) and is hereby also named as respondent herein. Dated: 16-6477-356 Rev. 09-2011 (Family Law) by: PETITION FOR CONCILIATION American LegalNet, Inc. www.FormsWorkFlow.com