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ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

TELEPHONE NO.: FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL 939 W. Main Street

El Centro, CA 92243

PETITIONER: RESPONDENT: OTHER PARENT: STIPULATION AND WAIVERS FOLLOWING MEDIATION; CASE NUMBER: ORDER THEREON After attending mediation on (date) ______________, the parties were able to reach a full agreement on contested custody and visitation issues, contained in the attached Mediation Agreement dated ______________. The parties declare and stipulate as follows:

1. We agree to comply with the terms set forth in the attached Mediation Agreement. Date: ______________ Mediator: _______________________________
2. Each of us has knowledge of the hearing currently scheduled in this matter and waive our right to proceed with that hearing based upon the attached custody/visitation agreement reached between us.
3. The court has jurisdiction to make child custody orders in this case under the Uniform Child Custody Jurisdiction and Enforcement Act (part 3 of the California Family Code, commencing with section 3400) as California is the child(ren)’s home state.
4. Each of us had notice of the custody/visitation proceeding and were both given an opportunity to be heard.
5. We agree the habitual place of residence of the child(ren) is the United States of America, County of Imperial.
6. We acknowledge being advised that a violation of our custody/visitation agreement and this court order may subject us to civil or criminal penalties, or both. Date:_________________ ______________________________________ Signature of Petitioner

Date:_________________ ______________________________________ Signature of Respondent Date:_________________ ______________________________________ Signature of Other Parent/Claimant ORDER FOR COURT USE ONLY Order to Show Cause/Notice of Motion hearing scheduled on __________ at _________ a.m. p.m. in Dept._____ is: VACATED. Custody and visitation are the only issues and have been resolved. REMAINS ON CALENDAR. There are additional issues to be resolved. Based upon the agreement of the parties, the Court adopts Mediation Agreement.

Date:_________________ ______________________________________ Judge of the Superior Court Mandatory Use FL-24 (Adopted 01/01/13, STIPULATION AND WAIVERS FOLLOWING MEDIATION; Revised 01/01/14) ORDER THEREON