COURT UNTY . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : Index No. Case Number: ________________________ (Numero de su caso) (Fecha de sentencia) Calendar No. Sentence Date: ________________________ -against1. General Information (Informacion general) : JUDICIAL SUBPOENA Plaintiff(s) / DOR FINANCIAL STATEMENT COURT (Corte / DOR Reporte de Estado Financiero) : : : ______________________________ ____________________________ ____________________________ (_____) _____________________ ____________________________ ____________________________ __________________State:______ ____________________________ Make (marca) Model (modelo) ____________________________ Year License No. / ST SELF (sugo) SPOUSE (esposo/esposa) ____________________________ a. Name: (Nombre) ______________________________ b. Address: (Domicillio) (ciudad, estado, codigo postal) Defendant(s) : . . . . . . . . . . . . . . .City, .State, . . . . . . . . . . . . . . . . . . . .______________________________ . . . . . . . Zip ........ c. Telephone Number: (numero de su telefono) (_____) _______________________ ______________________________ ______________________________ __________________State:_______ ______________________________ Make (marca) Model (modelo) ______________________________ Year License No. / ST E PEOPLE OFd. Date of Birth: NEW YORK THE STATE OF (fecha de nacimiento) e. Social Security Number: (numero de su seguro social) f. Driver's License Number: (numero de su licencia de manejar) g. Automobiles Owned: EETINGS: (automobile de su propriedad) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before (ano) (licencia/estado) (ano) (licencia/estado) , Honorable at the Court 2. Dependents in household under age 18: ________________________________________________________ located at hogar menores de 18 anos) nty of (cuantos dependientes en su oom , on the day of , 20 , at o'clock in the noon, and at any recessed djourned 3. List Banking give sus bancos) a witness in this action on the part of the date, (informacion lista de evidence as to testify and Information: Bank Name: (nombre del banco) _____________________ Branch: (rama) ___________________ Account No.: (numero de cuenta) _______________________ CHECKING: (CHEQUES) SAVINGS: (AHORROS) Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to party on whose behalf this subpoena was issued for a maximum ____________________ CHECKING: penalty of $50 and all damages sustained as aSAVINGS: ___________________ _________________ (CHEQUES) (AHORROS) lt of your failure to comply. ___________________ _________________ ____________________ CHECKING: (CHEQUES) SAVINGS: (AHORROS) Witness, Honorable 4. Employment Information: rt in County, day of (Informacion lista de sus trabajo) a. Employer's Name: (en donde trabaja) , one of the Justices of the , 20 ______________________________ ______________________________ ______________________________ (_____) _______________________ ____________________________ ____________________________ ____________________________ (_____) _____________________ $___________________________ b. Employer's Address: (direccion de su empleado) (Attorney must sign above and type name below) City, ST Zip (ciudad, estado, codigo postal) c. Telephone Number: (numero de su telefono) Attorney(s) for d. Salary before taxes: (salario untes de impuestos) $_____________________________ 5. Nearest Relative (not living with you): (miembro de su familia mas cercana:que no vive con usted) Office and P.O. Address Facsimile No.: E-Mail Address: Mobile Tel. __________________________________________________ No.: Signature (firma) Date (fecha) Name: ______________________________ Address: ____________________________________________ (nombre) (domicilio) Telephone Number : (____)______________ City, State, Zip: _______________________________________ Telephone No.: (numero de telefono) (ciudad, estado, codigo postal) American LegalNet, Inc. www.USCourtForms.com TR-7000 REV. 10/04