Merced — MSC-FL-035

Source: https://www.merced.courts.ca.gov/system/files/forms-and-filings/msc-fl-035-request-separate-ccrc-session-ada-comp.pdf

MSC-FL-035 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and address) FOR COURT USE ONLY

Attorney for (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MERCED 2260 “N” Street, Merced, CA 95340 1159 “G” Street, Los Banos, CA 93635 FAMILY LAW PETITIONER: CASE NUMBER: RESPONDENT:

REQUEST FOR SEPARATE CCRC SESSION (FAMILY CODE §3181) CCRC DATE:

Although CCRC is typically accomplished through the simultaneous presence and participation of both parties to the court case, under certain specified conditions separate CCRC sessions may be arranged if either of the following conditions exist:

1. There is a history of domestic violence between the parties (as defined in Family Code 6211). The party allegedly suffering from domestic violence may request that separate CCRC sessions be performed.

2. There is in existence a protective restraining order against one of the parties. The party who is protected by that order may request that separate CCRC sessions be performed.

A party eligible for separate CCRC counseling sessions may, in the alternative, have a third party accompany him or her to a non-separate CCRC session and act as a support person.

A party inclined to request separate CCRC sessions or use a support person must inform Family Court Services of this desire by completing and returning this form as soon as possible.

NAME: _________________________________________ CASE NO.: ____________________

ADDRESS: ____________________________________________________________________

TELEPHONE (daytime): __________________________________________________________

CCRC DATE: ___________________________________________________________________

NEXT COURT HEARING DATE: _____________________________________________________

PROPOSED SUPPORT PERSON (IF APPLICABLE): _______________________________________

(Please complete page 2)

For Optional Use REQUEST FOR SEPARATE CCRC SESSION Page 1 of 2 MSC-FL-035 [Rev. May 29, 2020] (FAMILY CODE §3181)

MSC-FL-035 CASE NAME: CASE NUMBER:

Petitioner Respondent hereby submits this written request for a separate CCRC Session.

I am a victim of domestic violence. The facts supporting this claim are:

I have an existing domestic violence restraining order against the other party in the present case.

I have had a domestic violence restraining order against the other party in the past, although I do not have

one currently against the other party.

I have had a history of domestic violence in the past with the other party in the present case, but have had

no restraining order against that party. The circumstances of that history are:

I am protected person under a current Domestic Violence Restraining order.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

SIGN

Dated: _____________________ ______________________________________________ Signature

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Name of Declarant (Printed)

For Optional Use REQUEST FOR SEPARATE CCRC SESSION Page 2 of 2 MSC-FL-035 [Rev. May 29, 2020] (FAMILY CODE §3181)