COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: Index No. FOR COURT USE ONLY ID-110 : Plaintiff(s) -against: : : : Calendar No. JUDICIAL SUBPOENA NAME OF DEFENDANT: STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: HOME TELEPHONE NO.: WORK TELEPHONE NO.: DRIVER'S LICENSE NO.: Defendant(s) : ...................................................... DATE OF COURT ORDER: THE PEOPLE OF THE STATE OF NEW YORK IGNITION INTERLOCK INSTALLATION VERIFICATION CASE NUMBER: TO 1. Manufacturer: 2. Facility location (address): 3. Vehicles: GREETINGS: Make a. b. Model Year Color License Plate No. VIN: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court c. County of located at in Nos. , on the day of , 20 b. , at o'clock in the c. noon, and at any recessed a. 4. Serialroomof units: or adjourned date, to testify and give evidence as a witness in this action on the part ofc. the a. b. Odometer reading: 5. 6. Date of installation: 7. Date of next monitor check: a. a. b. b. c. c. Your failure to comply with this State of California that the foregoing is true and correct. I declare under penalty of perjury under the laws of thesubpoena 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 Date: result of your failure to comply. Witness, Honorable Court in (TYPE OR PRINT NAME OF INSTALLER) day of County, Original sent to (name of court): For installer use only: , one of the Justices of the , 20 (SIGNATURE OF INSTALLER) (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Distribution: Court, Manufacturer or Manufacturer's Agent, Defendant, Probation Department Form Approved for Optional Use Mobile Tel. No.: IGNITION INTERLOCK INSTALLATION VERIFICATION Judicial Council of California ID-110 [Rev. July 1, 2005] Page 1 of 1 Vehicle Code, § 23575 www.courtinfo.ca.gov (Ignition Interlock Device) American LegalNet, Inc. www.USCourtForms.com