COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. PLACER COUNTY FAMILY COURT SERVICES WORK SHEET Both parties should complete ALL information on the FORM. Legibly and in ink only. Please print. : Calendar No. Case Number:____________________________________ : JUDICIAL SUBPOENA Plaintiff(s) Indicate other Placer County cases filed in this Court, i.e.: Guardianship, Juvenile, Criminal -against: Case no.: ______________ Title of Case: ___________________________________________ Case no.: ______________ Title of Case: ___________________________________________ : _________________________________________ vs. ________________________________________________ : Petitioner Respondent _________________________________________ ________________________________________________ : Mailing .Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Defendant(s) . . . . . .Address Mailing . ...... .......... _________________________________________ ________________________________________________ City, State, Zip Code City, State, Zip Code _________________________________________ ________________________________________________ Telephone Number / Message Number OF NEW YORK Telephone Number / Message Number THE PEOPLE OF THE STATE _________________ ______________________ _______________________ ______________________ Date of Birth Driver’s License # Date of Birth Driver’s License # TO _________________________________________ ________________________________________________ Social Security Number Social Security Number _________________________________________ ________________________________________________ Place ofGREETINGS: Employment Place of Employment _________________ _____________________ _______________________ ______________________ City Work Phone City being laid aside, you and Workof you attend before WE COMMAND YOU, that all business and excuses each Phone Significant Other’s Name: ____________________ Significant Other’s Name: __________________________ , the Honorable at the Court Other Cases Related to the Family? ____________ Other Cases Related to the Family? ___________________ located at County of _________________________________________ ________________________________________________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed Attorney’s Name Attorney’s Name or adjourned date, to testify and give evidence as a witness in this action on the part of the _________________________________________ ________________________________________________ Attorney’s Full Address Attorney’s Full Address _________________________________________ ________________________________________________ Attorney’s Telephone Numberto comply with this subpoena is punishable asTelephone Number and will make you liable to Attorney’s a contempt of court Your failure the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Full names of minor children to comply. Age Birthdate Primary Residence Name of school . result of your failure Date: _______________________ ______________________________ ___ _________ Witness, Honorable Court in County, of ______________________________ ___ day _________ __________________ ________________ , one of the Justices of the , __________________ 20 ________________ ______________________________ ___ _________ __________________ ______________________________ ___ _________ __________________ __________________ Length of Relationship MUST BE COMPLETED (Attorney must sign above and type name below) _______________ Previous Mediator Mediator / Court Use Only Request for separate mediation? ______ yes or ______no _____ Refer to FCS Evaluation ____ Agree/rec at Assessment (case concluded) ____ Rec at Assessment (case concluded) _____________________ Dates of Prior Mediation(s_ Office and Case Address P.O. Disposition ____ Agree at Assessment (case concluded) Is there a history of domestic violence? ____yes or ____ no ________________ Attorney(s) for IMPORTANT INFORMATION _________________ Separation Date ________________ _____ Refer to FCS Investigation Telephone No.:Focus:______________________________ _____ Facsimile No.:Refer to Private Evaluation E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com