COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. FOR COURT OR OFFICIAL USE ONLY: : Plaintiff(s) -against- Calendar No. : JUDICIAL SUBPOENA : GOVERNMENT CLAIM (JUDICIAL BRANCH) (GOVERNMENT CODE SECTION 910.4) : DATE STAMP Postmark date if received by mail: ___________ : CLAIMANT INFORMATION Defendant(s) Name of Claimant :Home Telephone ...................................................... Mailing Address City Work Telephone State Zip Code State Zip Code Send THE PEOPLE OF THE claim to OF different from above): notices regarding this STATE (if NEW YORK Name: TO Mailing Address CLAIM INFORMATION GREETINGS: Date of Incident (Month/Day/Year) City Time of Incident WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Location of Incident , the Honorable at the Court located at County of Describe the indebtedness, obligation, injury, damage, or loss incurredo'clock in theof thenoon, and at any recessed as a result incident. in room , on the day of , 20 , at or adjourned date, to testify and give evidence as a witness in this action on the part of the 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 $50 and all damages sustained as a result of your failure to comply. State the circumstances that gave rise to this claim. (State the facts that support your claim and why you believe the court or other judicial branch entity is responsible for the alleged ,damage orJustices of the Witness, Honorable one of the injury.) If known, provide the name(s) of the official(s) or employee(s) who allegedly caused the injury, damage, or loss. If more Court in County, day of , 20 space is needed, please attach additional sheets. (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : JUDICIAL SUBPOENA Plaintiff(s) If the amount of your claim is more than $10,000, If the total amount of your claim is up to $10,000: -against: indicate whether your claim would be a limited civil case or unlimited civil case (check one): Amount of damages as of this date: _____ Estimated amount of future damages: _____ : Total amount claimed: _____ Limited Civil (amount is $25,000 or less) Unlimited Civil (amount is more than $25,000) : Defendant(s) State how the amount of your claim was computed (include copies: of supporting documentation such as billing ...................................................... statements, invoices, receipts, estimates, etc.). THE PEOPLE OF THE STATE OF NEW YORK TO Names, addresses, and telephone numbers of all witnesses to the incident: GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court County ofinformation that might located at in considering this claim: Any additional be helpful 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 Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whoseINFORMATION (Complete if for a maximum penaltyperson acting on claimant’s behalf.)as a REPRESENTATIVE behalf this subpoena was issued claim is presented by a of $50 and all damages sustained result of your failure to comply. Name of Authorized Representative Telephone Witness, Honorable Mailing Address Court in County, City day of , one of the Justices of Zip Code State the , 20 PLEASE NOTE: Presentation of a false claim, with intent to defraud, is a criminal offense. (Penal Code (Attorney must sign above and type name below) section 72.) Signature of Claimant or Authorized Representative Attorney(s) for (check one) Date Deliver or mail this claim form to: Attention: Court Executive Officer (Claims) Superior Court of California, County of Fresno 1100 Van Ness Avenue Fresno, CA 93724-0002 Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com