COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : JUDICIAL SUBPOENA Plaintiff(s) UNITED STATES BANKRUPTCY COURT -against: NORTHERN DISTRICT OF CALIFORNIA In re: Chapter 13 Case No. R.S. No. : : Defendant(s) FOR :PROOF OF INSURANCE DEMAND ...................................................... ON MOTOR VEHICLE WITH CERTIFICATE OF SERVICE Vehicle Description: Debtor(s) Secured Creditor/Lessor: THE PEOPLE OF THE STATE OF NEW YORK ________________________________________/ TO TO THE DEBTOR(S): ACT NOW OR YOU WILL LOSE YOUR VEHICLE The secured creditor or lessor believes that you do not have adequate collision and comprehensive insurance coverage on your vehicle. YOU MUST PROVIDE PROOF OF INSURANCE. GREETINGS: * IF YOU HAVE AN ATTORNEY, HAVE YOUR ATTORNEY RESPOND FOR YOU IMMEDIATELY. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before * IF YOU DO HAVE INSURANCE NOW, provide the following information to the creditor's attorney at the , the Honorable at the Court address listed above: located at County of The name of your insurance company; 1. in room , on the day of , 20 , at o'clock in the noon, and at any recessed 2. The name and telephone number of your agent; and or adjourned date, to testify and give evidence as a witness in this action on the part of the 3. Your insurance policy number. * IF YOU DO NOT HAVE INSURANCE, YOU MUST GET INSURANCE IMMEDIATELY. As soon as you have insurance, provide the above information to the creditor's attorney. 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 $50YOUR VEHICLE TO BE as a WARNING: THE CREDITOR WILL REQUEST A COURT ORDER ALLOWING and all damages sustained result of your AND to comply. REPOSSESSEDfailure SOLD if the creditor's attorney has not received proof of insurance by 5:00 p.m. on _____________________________, (at least 14 days from the date of this demand). If an Order for repossession Witness, Honorable , will of NO COURT HEARING, is sought, you will have an opportunity to request a court hearing. However, there one be the Justices of the unless you in request one and explain in detail why there is good reason for the hearing. Even if you request a hearing, Court County, day of , 20 the Court may not agree that your explanation justifies a hearing and the Court may deny your request for a hearing. Dated:_____________________ ______________________________________________ (Attorney Attorney for Creditor must sign above and type name below) CERTIFICATE OF SERVICE Attorney(s) for I am not less than 18 years of age and not a party to the within case. My business address is: ______________________________________________________________. I served this DEMAND FOR PROOF OF INSURANCE ON MOTOR VEHICLE by first-class United States mail, postage pre-paid, at __________________ ______________________ on the date noted below and addressed to the debtor(s) and the debtor(s)' attorney as listed below. I declare under penalty of perjury that the foregoing is true and correct. Office and P.O. Address Dated:_____________________ * * * * rev. 4/04 * * * * ______________________________________________ Telephone No.: * * Facsimile No.: * E-Mail Address: * Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com