Request For Confidential Mediation Regarding Visitation

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PR-E-LP-025
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address,
Telephone & State Bar Number):
Attorney for: (Name)
Superior Court of California, County of Sacramento
STREET ADDRESS: 3341 Power Inn Road
MAILING ADDRESS: Same
CITY & ZIP CODE: Sacramento, California 95826
GUARDIANSHIP OF THE
PERSON
ESTATE OF:
(Name)
, a Minor(s)
Probate Case Number:
REQUEST FOR CONFIDENTIAL MEDIATION
REGARDING VISITATION
1. A request for the court to order mediation has been requested by
,
(petitioner)
.
(relationship to minor(s))
2. CHILDREN AT ISSUE
NAME
DOB
SCHOOL
RESIDES WITH
(Name & Address)
a.______________________________________________________________________________________
b.______________________________________________________________________________________
c.______________________________________________________________________________________
Name of Children(s) Attorney: (if applicable)
Name:__________________________________
Street Address:___________________________
City/State/Zip:____________________________
Telephone Number:_______________________
Provide all requested names, mailing addresses, telephone numbers and attorney information of the
3.
persons listed in attachment 3 to the best of your ability. Use business addresses only when the home
address are unavailable.
1 of 4
Page
PR-E-LP-025 (Revised 1/11/16)
Request for Confidential Mediation Regarding Visitation
Local Rule 4.33
Mandatory

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