Attorney's Name, Address & Phone: UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA United States of America CASE NUMBER PLAINTIFF v. SUBPOENA IN A CRIMINAL CASE DEFENDANT(S) TO: G YOU ARE HEREBY COMMANDED to appear in the United States District Court at the place, date and time specified below to testify in the above case. Place: Date: , Time: . , Courtroom: G YOU ARE ALSO COMMANDED to bring with you the following document(s) or object(s): Kiry K. Gray, Clerk of Court CR-21 (10/15) Date SUBPOENA IN A CRIMINAL CASE Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com PROOF OF SERVICE Received by Server Served SERVED ON (PRINT NAME) DATE PLACE DATE PLACE FEES AND MILEAGE TENDERED TO WITNESS G Yes G No Amount $ SERVED BY (PRINT NAME) TITLE DECLARATION OF SERVER I declare under penalty of perjury under the laws of the United States of America that the foregoing information contained in the Proof of Service is true and correct. Executed on Date Signature of Server Address of Server: ADDITIONAL INFORMATION CR-21 (10/15) SUBPOENA IN A CRIMINAL CASE American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2