COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : Index No. Calendar No. JUVENILE COURT : NEVADA COUNTY JUDICIAL SUBPOENA Plaintiff(s) -against: : CASE NO.________________________ IN THE MATTER OF: R.R.D. NO.________________________ : Defendant(s) a minor : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . COURT ORDER TO REPORT FOR . D.O.B. FINANCIAL EVALUATION (W&I 903.45) THE PEOPLE OF THE STATE OF NEW YORK ADVISEMENT TO PARENTS TO When a child is in out of home placement, a parent may be liable to the county for reimbursement for support paid on behalf of the child. The filing of an action for reimbursement may extend back, up to one year. This liability may be forgiven in certain GREETINGS:circumstances depending upon family income and successful reunification. The parents may wish to contact the Office of the Family Court Facilitator for information, formsYOU, that all business concerning this obligation. This of you attend before WE COMMAND and assistance and excuses being laid aside, you and each obligation is in addition to any other reimbursement at the obligation. , the Honorable Court located at County of in room ____________________________, 20 , on the day of , Parent(s)/Person(s) liability fornoon, and at any recessed , at o'clock in the TO: costs. or adjourned date, to testify and give evidence as a witness in this action on the part of the IT IS ORDERED, that you appear before the County Financial Evaluation Officer and provide all information regarding your financial status (If you do not appear as ordered, the Court may in your absence order you tothis subpoena is punishable such costs): of court and will make you liable to Your failure to comply with pay the full amount of as a contempt the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of Immediately comply. this hearing at 201 Church Street, Suite 1, Nevada City, CA 95959 your failure to following Within five (5) court days after release from custody at 201 Church Street, Nevada City, CA 95959 Witness, Honorable , one of the Justices of the Upon the Financial Officer's request or scheduled appointment. Court in County, day of , 20 Other: _________________________________________________________________ __________________________________________________________________________ (Attorney must sign above and type name below) DATED: ________________ RECEIVED COPY: Signature Address City, State & Zip Code ___________________________________ Attorney(s) Nevada County Courts Judge of thefor Date of Birth Driver's License Number Social Security Number 300 601 602 Office and P.O. Address Phone Number No.: Telephone Facsimile No.: E-Mail Address: Mobile Tel. No.: ________________________________________________________________________________________________________________________________________________________________________ COURT ORDER TO REPORT FOR FINANCIAL EVALUATION LOCAL JV4(Effective 7/1/03) American LegalNet, Inc. www.USCourtForms.com