LABOR COMMISSIONER, STATE OF CALIFORNIA Department of Industrial Relations Division of Labor Standards Enforcement TO: STATE CASE NUMBER INFORMATION FOR SUBPOENA In regards to your request for a subpoena pursuant to Labor Code sections 74 and 92, please complete the following information and return this form to the Division of Labor Standards Enforcement (DLSE) office hearing your case at least 15 business days prior to the hearing. For a listing of addresses of DLSE District Offices please see http://www.dir.ca.gov/dlse/DistrictOffices.htm. Upon receipt of this form, a decision will be made as to whether or not a subpoena will be issued and you will be advised. Please be aware that you will be responsible for having the subpoena served, and for any costs incurred. Dated: State Labor Commissioner Deputy Labor Commissioner 1. Name and address of the person(s) you want subpoenaed: 2. What will the person testify to? 3. If you want documents or records, please give the DATES the document or record covers and what the document or record is. Provide as detailed a description as possible of the document or record sufficient to be able to identify the document or record being sought. 4. What does this document or record show that is not available to you? 5. Name and address of the person(s) who has possession of this document or record: Your signature: Telephone Number: DLSE 564 (Rev. 1/09) Date: INFORMATION FOR SUBPOENA American LegalNet, Inc. www.FormsWorkflow.com