ATTACHMENT FM-1112 SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: FOR COURT USE ONLY 201 North First Street, San José, CA 95113 191 North First Street San José, California 95113 Family Justice Center PETITIONER: RESPONDENT: STIPULATION FOR COURT COMMISSIONER TO ACT AS TEMPORARY JUDGE FOR ALL PURPOSES CASE NUMBER: Commissioner , is a judicial officer of the Superior Court of California, County of Santa Clara, and may act as a Temporary Judge if all the parties agree in writing. Your signature below means you agree the above-named Court Commissioner shall act as a Temporary Judge for all purposes in this matter until final determination of the case, including all post-trial matters. Dated: SIGNATURE PRINTED NAME OF PARTY AND/OR ATTORNEY (/Petitioner) (Attorney for Petitioner) (Respondent) (Attorney for Respondent) (Claimant/Other Party) (Attorney for Claimant/Other Party) Interpreter Witness Declaration Interpreter: The a. b. Petitioner Respondent is unable to read or understand this Stipulation because: his/her primary language is (specify): other (specify): I certify under penalty of perjury under the laws of the State of California that I have, to the best of my ability, read or translated for the Petitioner Respondent this Stipulation. He or she said they understood this Stipulation before signing it. Date Interpreter's printed name Interpreter's signature FM-1112 REV 7/1/11 STIPULATION FOR COURT COMMISSIONER TO ACT AS TEMPORARY JUDGE FOR ALL PURPOSES American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 1