Santa Clara — FM-1191

Source: https://santaclara.courts.ca.gov/system/files/forms/fm-1191_rem.pdf

ATTACHMENT FM-1191

ATTORNEY OR PARTY WITHOUT AN ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: FOR COURT USE ONLY

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA STREET ADDRESS: 201 North First Street, San José, CA 95113 MAILING ADDRESS: 191 North First Street CITY AND ZIP CODE: San José, California 95113 BRANCH NAME: Family Justice Center

PLAINTIFF/PETITIONER:

DEFENDANT/RESPONDENT:

CASE NUMBER:
REFERRAL TO POST-MEDIATION HEARING (PMH)
FCS NUMBER: APJ:

1. The parents and other party/parties (list names):_________________________________________________

   participated in mediation with Family Court Services (FCS) or a private provider

on (date): ______________________. The mediation process is complete.

2. The parties: reached a partial agreement, which is submitted to the court as a separate document; or

   were unable to reach an agreement.

3. The parties are referred to a Post-Mediation Hearing (PMH).

4. The parties are referred to a PMH for the following issues: Legal Custody

   Physical Custody

   Timeshare/Parenting Time

   Holiday Schedule

   Miscellaneous Unresolved Parenting Issues

5. The court will send notice of the hearing date and time to the parties.

Dated: Signature of FCS Mediator Party Attorney for Party

Type or Print Name

NEW 07/01/20 FM-1191 REFERRAL TO POST-MEDIATION HEARING (PMH) Page 1 of 1 For Mandatory Use