COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : FINANCIAL AFFIDAVIT : Index No. Calendar No. PERSONAL FINANCIAL DATA Plaintiff(s) A. Your full name and present mailing address: -against- : JUDICIAL SUBPOENA : : : Telephone: Defendant(s) : . .B.. . . . . Are. you. presently. employed? . .Yes ._______________ No _______________ . ... ... ........ .......... ... ............. If your answer is "yes" give the name and address of your employer and the amount of THE PEOPLE OF THE STATE OF NEW YORK your usual weekly salary or wages . TO Weekly earnings $____________________ GREETINGS: If you are not presently employed, give the name and address of your last employer, when WE COMMAND YOU,the amount of weekly salary or wages youyou and each of you attend before you last worked, and that all business and excuses being laid aside, were receiving. , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed Date last testify and ____________________ or adjourned date, toworked: give evidence as a witness in this action on the part of the Weekly earnings: $____________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to C. Approximately how much money have you maximum penalty of $50 and all damages sustained as a the party on whose behalf this subpoena was issued for a received in the past twelve months: result of your failure to comply. as wages, salary, commissions or earned income of any kind? Witness, Honorable Court in County, , one of the Justices of the $____________________ day of , 20 as interest, dividends, rents or investments or any kind? (Attorney must sign above and type name below) $____________________ as gifts or inheritance? Attorney(s) for $____________________ Office and P.O. Address from social security, unemployment compensation or any form of state or federal welfare payments or benefits? $____________________ Telephone No.: Facsimile No.: E-Mail Address: from pensions, annuities, workmen's compensation, disability or other insurance Mobile Tel. No.: policies? American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : $____________________ Index No. : from all other sources? Plaintiff(s) -against- Calendar No. : JUDICIAL SUBPOENA : $____________________ : D. How much money do you own of have in any checking or savings accounts? : $____________________ : Defendant(s) ...................................................... E. Do you own any real estate, stocks, bonds, notes, automobiles, boats, or other valuable property (excluding household items and clothing)? THE PEOPLE OF THE STATE OF NEW YORK Yes ________________ No ________________ TO If the answer is "yes," describe the property and state its approximate value: GREETINGS: WE COMMAND YOU, you owe to others? excuses being laid aside, you and each of you attend before F. How much money do that all business and , the Honorable at the Court located at County of $____________________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the As to each debt over $100.00, state the name of the creditor and the amount owed: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a G. List the person who are result of your failure to comply. dependent upon you for support, stating your relationship to them and how much you contribute each year toward their support. Witness, Honorable Court in County, H. , one of the Justices of the day of , 20 Are there any other persons regularly residing in your household who are over the age of eighteen and who are presently employed? (Attorney must sign above and type name below) Yes ________________ No ________________ Attorney(s) for If the answer is "yes," give the following information for each such person: Name: Office and P.O. Address Relationship: Employer: Weekly earnings: Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : I. Index No. Calendar No. : JUDICIAL SUBPOENA Any other information which you believe supports your claim that you cannot financially Plaintiff(s) afford to make payment of court fees. -against: : : Under penalty of perjury, I declare that the information given on the preceding pages is Defendant(s) : . .true. and.correct.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... ...... THE PEOPLE OF THE STATE OF NEW YORK Date:________________________________________ TO Signature GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed 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 contempt of court and will make you liable to 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, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com