ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number, and Address): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF SONOMA STREET ADDRESS: 3055 CLEVELAND AVENUE MAILING ADDRESS: 3055 CLEVELAND AVENUE CITY AND ZIP CODE: SANTA ROSA 95403 BRANCH NAME: CIVIL AND FAMILY LAW COURTHOUSE PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER: STIPULATION AND ORDER FOR INTERIM CHILD CUSTODY MEDIATION CASE NUMBER: 1. The parties agree to the following: a. Child Custody and Visitation/Parenting Time: b. Other orders: As attached on form FL-341 As attached 2. All other issues are reserved until further order of the court. 3. All orders previously made in this action remain in full force and effect except as specifically modified herein. 4. This agreement is a temporary/interim agreement and is without prejudice to either parent's right to request different custody orders at a future court hearing. 5. The Family Court Services date of __________________________________________ and the court hearing date of _______________________ shall be dropped upon the filing of this Stipulation.* *In the event that there are non-custody/visitation/parenting time issues calendared for the hearing, then only the custody/visitation/parenting time issues will be dropped.** Date: __________________________________________ (TYPE OR PRINT NAME) _____________________________________________ SIGNATURE OF PETITIONER/PLAINTIFF Date: ___________________________________________ (TYPE OR PRINT NAME) _____________________________________________ SIGNATURE OF ATTORNEY FOR PETITIONER/PLAINTIFF Date: ___________________________________________ (TYPE OR PRINT NAME) _____________________________________________ SIGNATURE OF RESPONDENT/DEFENDANT Date: ___________________________________________ (TYPE OR PRINT NAME) _____________________________________________ SIGNATURE OF ATTORNEY FOR RESPONDENT/DEFENDANT Date: ___________________________________________ (TYPE OR PRINT NAME) _____________________________________________ SIGNATURE OF OTHER Date: ___________________________________________ (TYPE OR PRINT NAME) _____________________________________________ SIGNATURE OF ATTORNEY FOR OTHER IT IS SO ORDERED. Date: Local Form FL-036 _____________________________________________ JUDICIAL OFFICER STIPULATION AND ORDER FOR INTERIM CHILD CUSTODY MEDIATION American LegalNet, Inc. www.FormsWorkFlow.com Form Adopted for Mandatory Use Eff.,2/2014