COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Municipal Court County Court District Court Calendar No. _________________________________________ County, Colorado Court Address: : JUDICIAL SUBPOENA Plaintiff(s) Plaintiff(s)/Petitioner(s): -against- : : v. COURT USE ONLY : Defendant(s)/Respondent(s): Defendant(s) : Attorney . . . . . . . . . . . . . . . . . (Name . . . . . . . . . . . . . . . . . . . . .or .Party .Without. Attorney . . . . . . and.Address):. . . . . . Case Number: Warrant Number: Phone Number: E-mail: THE PEOPLE OF THE STATE OF NEW YORK Division Atty. Reg. #.: MOTION TO WAIVE OR POSTPONE COSTS AND ORDER FAX Number: TO Courtroom I request the Court to allow me to file a Verified Complaint for Protection Order without payment of court costs, and in support of my request submit the following information under oath. 1. My occupation is: __________________________________________________________________________________. GREETINGS: I am employed _____________hours per week. 2. I am unemployed. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before 3. My gross monthly income (before deductions) is as follows (include ALL sources of income such as wages or salary, , the Honorable at the Court AFDC, located at County of child support, maintenance, food stamps, unemployment or worker’s compensation): $ _____________________. in 4. Other monthly, income to the household not listed in20 $ ___________________________. noon, and at any recessed room on the day of , 3: , at o'clock in the or 5. There are _____________adults and ______________children living in my household.of the adjourned date, to testify and give evidence as a witness in this action on the part 6. I can cannot pay the filing fee now. I DECLARE UNDER PENALTY OF PERJURY THAT THE ABOVE STATEMENTS ARE TRUE. 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 DATE: ________________________________________ ___________________________________________ result of your failure to comply. Plaintiff/Defendant Subscribed and affirmed, or sworn to before me in the County of ______________________, State of ________________, Witness, Honorable Court in County, this ___________ day of _______________, 20 _______. day of , one of the Justices of the , 20 My Commission Expires: ________________________ ___________________________________________ Notary Public/Clerk (Attorney must sign above and type name below) ORDER Court costs are waived. Attorney(s) for Payment of court costs is postponed until (date) ________________________. The Defendant may be ordered to pay the Plaintiff’s court costs. The motion to waive or postpone costs is denied. Office and P.O. Address Dated: ___________________________________ BY THE COURT: Telephone No.: Facsimile No.: Judge E-Mail Address: Mobile Tel. No.: JDF 403 R7/03 MOTION TO WAIVE OR POSTPONE COSTS AND ORDER Magistrate American LegalNet, Inc. www.USCourtForms.com