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ATTACHMENT FM-1016

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ATTACHMENT FM-1016
FM-1016 REV 07/01/20
For Mandatory Use
POST-MEDIATION HEARING/JUDICIAL CUSTODY CONFERENCE
STATEMENT
(CUSTODY / VISITATION / TIMESHARE)
Page 1 of 2
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:
POST MEDIATION HEARING (PMH)/
JUDICIAL CUSTODY CONFERENCE (JCC)
STATEMENT
(Custody / Visitation / Timeshare)
CASE NUMBER:
FCS NUMBER:
DATE: TIME: DEPARTMENT:
NOTICE
Before the date set for a PMH/JCC, all parties must confer regarding any remaining custody or visitation
disputes, unless existing restraining orders prohibit such a discussion. This completed form must be served
on the opposing party/counsel and the attorney for the minor children, if any and mailed or delivered to the
Superior Court Clerk, 201 North First Street, San Jose, CA 95113, to be filed at least ten (10) calendar
days before the date of the PMH/JCC.
a. Attorneys and parties representing themselves are to confer to completing this form. If there are
restraining orders in place which prevent such communication and both parties are representing
themselves, there is no requirement to confer. Each side must prepare and file a separate form.
b. Bring two filed copies of the completed form to the PMH/JCC.
c. Please contact the Calendar Clerk immediately if the custody and visitation matters have settled, so that
the appointment space may be filled by another case. PMH/JCCs may be continued only once and only
for good cause.
NOTE: ORDERS, INCLUDING MONETARY SANCTIONS, MAY BE ISSUED AGAINST YOU IF
YOU FAIL TO APPEAR AT A SCHEDULED PMH/JCC.
Please answer the following questions:
1. Have all parties conferred regarding the remaining custody or visitation disputes? Yes No
If yes, how many discussions of settlement have occurred?
If no, please explain:
2. Has the custody, visitation, or living arrangement of the children changed since mediation or the previous court
custody order? Yes No
If yes, explain:
3. What are the specific issues or points of disagreement regarding custody or visitation that need to be addressed at
the PMH/JCC?
ATTACHMENT FM-1016
FM-1016 REV 07/01/20
For Mandatory Use
POST-MEDIATION HEARING/JUDICIAL CUSTODY CONFERENCE
STATEMENT
(CUSTODY / VISITATION / TIMESHARE)
Page 2 of 2
PLAINTIFF/PETITIONER (Name):
DEFENDANT/RESPONDENT (Name):
CASE NUMBER:
4. Has either parent completed any programs, whether court ordered or otherwise, since mediation or previous court
orders for custody? (This would include programs such as parenting classes, substance abuse treatment
programs, domestic violence counseling, etc.) If so, please list:
5. Has any mental health professional assisted the parties or the children with the custody/visitation dispute? Please
list the names, addresses, and telephone numbers of the professionals below and include marriage or divorce
counseling, private mediation regarding custody, therapy, for the child, special master services. Please do not
include individual therapy for a parent unless this was specifically ordered by the Court.
6. Please check if any of the following have occurred since the time of mediation or the previous court order:
a. Police intervention in the family. Date:
b. Child Protective Services referral. Date:
c. Screening at Family Court Services Date:
d. Drug testing of either parent. Date:
e. Arrests or criminal convictions. Date:
If any of the above have occurred, please explain further:
7. PLEASE ATTACH A DETAILED SUMMARY OF THE CURRENT SCHEDULE AND YOUR DETAILED DAY BY
DAY PROPOSAL FOR THE CHILD(REN)’S SCHEDULE.
Dated:
Signature of Party or Attorney for Party
Type or Print Name of Party or Attorney
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ATTACHMENT FM-1016

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Completed 28 June 2021

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