COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .CLOCK IN:::::::Index No.[ ] 17th Judicial Circuit in and for Broward County Florida [ ] In the County in and for Broward CountyCalendar No.DIVISION:[ ] Criminal [ ] Traffic [ ] OtherAFFIDAVIT OF IDENTITY AND WRITTEN PLEA OF NOT GUILTYJUDICIAL SUBPOENAPlaintiff(s)-against-CASE NUMBER/ CITATION NUMBERTHE STATE OF FLORIDA VS.PLAINTIFFDEFENDANTSEX:AFFIANT'S NAME:Defendant(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ADDRESS:HOME TELEPHONE:SOCIAL SECURITY # :THE PEOPLE OF THE STATE OF NEW YORK TORACE:HEIGHT:DATE OF BIRTH:STATE:DRIVER LICENSE # :PLACE OF EMPLOYMENT: VEHICLES DRIVEN BY YOU: STATEMENT: I DENY EVER HAVING RECEIVED THIS CITATION EXPLAIN WHY YOU COULD NOT HAVE BEEN CITED FOR THIS VIOLATION, AND YOUR WHERE-ABOUTS AT THE TIME THE CITATION WAS ISSUED ON A SEPARATE SHEET OF PAPER AND ATTACH WITH ALL OTHER SUBSTANTIATING DOCUMENTS, OR ATTACH A NOTARIZED AFFIDAVIT/LETTER FROM YOUR EMPLOYER, IF YOU WERE AT WORK ON THE DATE AND TIME IN QUESTION. DO YOU KNOW WHO IS USING YOUR NAME? [ ] YESGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before BECAUSE:Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in room[ ] NOYour 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.HOW DO YOU KNOW THIS PERSON USED YOUR NAME? (IF YES, GIVE ANY INFORMATION THAT MAY BE HELPFUL TO THE COURT IN DETERMINING THE PERSONINVOLVED WITH THIS CITATION.)DATE OF BIRTH:NAME:, one of the Justices of theCourt in Witness, Honorableday of, 20 County,ADDRESS:HOME TELEPHONE: PLACE OF EMPLOYMENT: EMPLOYER'S ADDRESS: DID YOU FILE A POLICE REPORT OF STOLEN PROPERTY, WALLET, PURSE, DRIVER LICENSE, ETC? [ ] YES(Attorney must sign above and type name below)Attorney(s) for[ ] NO(IF YES, ATTACH A COPY OF THE REPORT)SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OFOffice and P.O. AddressAFFIANT'S SIGNATURE, 20Telephone No.: Facsimile No.: E-Mail Address:DEPUTY CLERKNOTARY PUBLICFORM.621COPY FEE: 699SEARCH FEE: 698Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com