COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar No. DO NOT SERVE OR SHOW THIS SHEET TO RESPONDENT Case Number : • Temporary • Temporary/Order • Temporary/Order JUDICIAL SUBPOENA Plaintiff(s) Restraining Order for Antiharassment for Protection -against: LAW ENFORCEMENT INFORMATION This completed form is required by law enforcement to enforce your order. Fill in the following : information as completely as possible. Type or print only. Addresses, birth dates and ID numbers for both parties are necessary to serve and enforce :your order. Birth date PETITIONER Name of Petitioner (Last, First, Middle) Defendant(s) INFORMATION : ...................................................... Contact Name& Phone Address Phone THE PEOPLE OF THE STATE OF NEW YORK RESPONDENT INFORMATION TO Name of Respondent (Last, First, Middle) Drivers License or ID Number (specify type) GREETINGS: Address Birth date Sex Race Nickname WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable Court Height Weight Eye Color at the Hair Skin Tone Build Relation to located at County of Color Petitioner 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 Employer Employer’s Address WORK Hours: Phone: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Vehicle Licensebehalf this subpoena wasand Model a maximum penalty of $50 and all damages sustained as a No. Vehicle Make issued for Vehicle Color Vehicle Year the party on whose result of your failure to comply. HAZARD Weapons: Guns/Rifles Knives Witness, Honorable INFORMATION County, Court in day of , 20 Describe in detail: Explosives of the Justices of the of , one Other Location Weapons • Vehicle • Residence • On Person (Attorney must sign above and type name below) CURRENT STATUS (For DV Orders Only) Does the respondent know you are trying to get this order (circle) Respondent’s History Includes: Yes No • Attorney(s) for Mental Health Problems Does the respondent know he/she may be moved out of home? Yes No Is the respondent likely to react violently when served? Yes No (Commitment, Treatment, Suicide Attempt, Other) • Assault • Assault with Weapons • Alcohol/Drug Abuse Office and P.O. Address DO NOT SERVE OR SHOW THIS SHEET TO THE PERSON RESTRAINED/RESPONDENT COURT CLERKS: GIVE THIS FORM TO LAW ENFORCEMENT. DO NOT FILE IN Telephone No.: THE COURT FILE. Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com