COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. : Calendar No. : JUDICIAL SUBPOENA REQUEST FOR CRIMINAL HISTORY Plaintiff(s) -against- TO: PETITIONER: (Person/Agency Requesting Info.). ......... : Office of the Clerk of Superior Court and State Court of Liberty County, Georgia Post Office Box 50 : Hinesville, Georgia 31310-0050 Attention: Criminal History : Defendant(s) : . . . . . . Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...... Address: City Phone Number: THE PEOPLE OF THE STATE OF NEW YORK SUBJECT: (Person Whose Criminal Record is to be Searched) TO State Zip Facsimile No.: Name: Address: City Phone Number: State D/O/B: Zip SS#: GREETINGS: PERMISSION FOR CRIMINAL HISTORY RECORDS SEARCH WE COMMAND (as subject), business the Clerk being Superior you and each of Court I, the person named above YOU, that all authorizeand excuses of the laid aside, Court and Stateyou attend before , at the Court ofthe Honorable Liberty County, Georgia, to release my Liberty County, Georgia, criminal history to the located at County of above-named petitioner. I hereby release and hold harmless the Clerk from any liability that may in room , on the day of , 20 , at o'clock in the noon, and at any recessed result from the use or misuse of my criminal history by the petitioner. or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contemptSubject and will make you liable to of court the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness Notary Public Court in Witness, Honorable County, , one of the Justices of the day of , 20 AFFIDAVIT OF PETITIONER I, the Petitioner named above, individually or on behalf of an agency, request that the Clerk of the Superior Court and State Court of Liberty County conduct a criminal history search on the (Attorney must sign above the misdemeanor above-named subject and forward a copy of any or all documents that evidence and type name below) or felony conviction of said subject in the above-named courts of Liberty County, Georgia. I hereby release the Clerk from any liability that may result from the use or misuse of such criminal history information. Attorney(s) for Witness Petitioner Office and P.O. Address Notary Public Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Liberty County Criminal History Form – 6/2001 American LegalNet, Inc. www.USCourtForms.com