Superior Court of California, County of Imperial
Name & Address: ________________________________ ________________________________ ________________________________ Telephone: _______________________ Attorney for or Self-Represented Petitioner/Respondent
SUPERIOR COURT OF THE STATE OF CALIFORNIA COUNTY OF IMPERIAL Petitioner: ) ) _________________________ ) ) vs. ) ) Respondent: ) ) _________________________ ) ) _________________________________)
Case No. _____________ Petitioner's/Respondent's Mandatory Settlement Conference Statement
Date: ______________ Time: ______________ Dept: ______________
I. MEET AND CONFER STATEMENT: A. Date of Conference:_______________ B. Method of Conference: In person/telephone/letter/email C. Issues Settled Are: (Be very specific) 1.
2.
3.
4.
Form Approved for Optional Use FL-04 (1 of 3) (adopted 7/1/07)
Superior Court of California, County of Imperial
D. Issues Not Settled Are: (Be very specific) 1. 2. 3. 4. E. If the parties failed to meet and confer, explain why in detail. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ II. STATISTICAL DATA: A. For Dissolution of Marriage or Domestic Partnership/Legal Separation/Annulment ONLY: 1. Date of Marriage or Registration:______________ 2. Date of Separation:_____________ 3. If marital status already terminated, date of termination_________. B. Petitioner's Age ____, Occupation ____________ and Gross Monthly
Income_________. C. Respondent's Age _____, Occupation ___________ and Gross Monthly
Income__________. D. Minor Children of this Relationship. For each state: Name/Date of Birth/Sex/Residing With: 1. 2. 3. 4. III. HISTORY OF THE PROCEEDINGS: (Briefly summarize prior court proceedings) ________________________________________________________________ ________________________________________________________________ ________________________________________________________________
Form Approved for Optional Use FL-04 (2 of 3) (adopted 7/1/07)
Superior Court of California, County of Imperial
IV. ATTACHMENTS AND EXHIBITS: A. Where issues include the division of assets and debts, counsel/parties shall attach completed Community, Quasi-Community and/or Separate Property Declarations B. (FL-160). C. Other relevant attachments may be included.
Instructions FL-04 (3 of 3) (adopted 7/1/07)