Circuit Court for Name City or County Case No. Name Apt. # City State Zip Code Area Code Telephone Street Address City State Zip Code Area Code Apt. # Telephone Plaintiff (CC-DR 59) Defendant REQUEST FOR HEARING or PROCEEDING Please schedule the above-captioned case for a hearing or proceeding of the following type: emergency hearing scheduling conference pendente lite hearing pretrial conference The following matters are at issue (check all that apply): divorce custody visitation child support alimony other: use and possession marital property marital award retirement interests attorney's fees / court costs trial on the merits uncontested hearing other: CERTIFICATE OF SERVICE I HEREBY CERTIFY that on this day of this Request for Hearing or Proceeding was mailed, postage prepaid to: , , a copy of Opposing Party or His/Her Attorney Address City Date State Signature American LegalNet, Inc. www.FormsWorkFlow.com Zip CC-DR 59 (Rev. 10/2015)