COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGEJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)IN THE MATTER OF:CASE NO. Respondent, alleged to be Mentally Ill.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOENTRY SETTING TIME FOR HEARING AND ORDERING NOTICEAn APPLICATION FOR COURT ORDERED MEDICATION was filed on by Dr. , Chief Clinical Officer/designee of North Coast Behavioral Health Care Systems (NBHS)-Toledo Campus. It is hereby ORDERED that a hearing upon the application be held before this Court on at o'clock .M. at North Coast Behavioral Health Care System (NBHS)-Toledo Campus 930 S. Detroit, Toledo, Ohio 43614. It is further ORDERED that written notice of said hearing shall be served by mail or otherwise upon the Respondent and other interested persons, except such persons who have waived the issuance of service of said notice or have otherwise been served.GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour 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., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below) DateAttorney(s) forJudge Jack R. PuffenbergerOffice and P.O. Address«ni315md;-Telephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:7/1/02FORM MH-204LC-ENTRY SETTING HEARING AND ORDERING NOTICE (MEDICATION)American LegalNet, Inc. www.USCourtForms.com