COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Fair Credit Reporting Act Disclosure Statement: Plaintiff(s) -against- Index No. Calendar No. JUDICIAL SUBPOENA : The Federal Fair Credit Reporting Act, as amended by the Consumer Credit Reporting Reform Act of 1996, permits : the procurement of consumer credit reports for employment purposes. : The Act provides that a clear and conspicuous disclosure shall be made in writing to the applicant before the report is procured, that a consumer report may be obtained for employment purposes and the applicant shall authorize the Defendant(s) : procurement of the report in writing. In using the report for employment purposes, before taking any adverse action ...................................................... based in whole or in part on the report, the subscriber shall provide the applicant a copy of the report and a copy of “Summary of Consumer Rights”. The information from the report will not be used in violation of any applicable federal or state equal employment law or regulation. THE PEOPLE OF THE Court has contracted with the Lincoln Credit Bureau of Lincoln, Nebraska to procure a The Nebraska Supreme STATE OF NEW YORK consumer credit report on each judicial vacancy applicant. A copy of the applicant=s report, instructions to the report, and “Summary of Consumer Rights” document will be mailed to the home address of the applicant as soon TO as possible after the filing deadline for the judicial vacancy. A copy of the applicant=s consumer credit report and instructions to the report will be included in the materials provided to each member and alternate member of the Judicial Nomination Commission. If the applicant=s name is submitted to the Governor for consideration, a copy of the consumer GREETINGS:credit report will be forwarded to the Governor. Any corrective documentation of the consumer credit report will be provided to the commission members and if applicable, to the Governor. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Authorization , the Honorable at the Court located at County of authorize the Nebraska Supreme Court to obtain a copy of my consumer credit report for employment I hereby inpurposes. 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 Name (Please Print) 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. Signature of Applicant Witness, Honorable Court in County, , one of the Justices of the day of , 20 Date Signed and sworn to this day of , . (Attorney must sign above and type name below) Notary Public Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: 12/98 – Pg. 4 of 5, APP American LegalNet, Inc. www.USCourtForms.com