ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address) FOR COURT USE ONLY TELEPHONE NO: ATTORNEY FOR (NAME): FAX NO: SUPERIOR COURT OF CALIFORNIA COUNTY OF YUBA 215 FIFTH STREET, SUITE 200 MARYSVILLE CA 95901 (530) 749-7600 PLAINTIFF/PETITIONER: vs. DEFENDANT/RESPONDENT: CASE NUMBER: COURT SPONSORED MEDIATION REPORT (Please return to the Court within 10 days of the mediation.) Name of Mediator: Mediation was: Successful Unsuccessful PLEASE RETURN THIS FORM WITHIN 10 DAYS OF THE MEDIATION TO: Yuba County Superior Court, Attn: Civil Clerk 215 Fifth Street, Suite 200 Marysville, CA 95901 NOTE: A fillable version of this form is available on the Court's website: www.yubacourts.org. Yuba County Superior Court Effective 2/28/08 COURT SPONSORED MEDIATION REPORT CV08018 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com