COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : : Index No. Calendar No. IN THE COURT FOR INDIAN RIVER COUNTY, FLORIDA Plaintiff(s) -againstIN RE: ESTATE OF PROBATE JUDICIAL SUBPOENA DIVISION : CASE NUMBER __________________________________ CP : : Defendant(s) : . . . . . . . . . . . . . . . Deceased. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... STATEMENT OF CLAIM THE PEOPLE OF THE STATE OF NEW YORK TO The undersigned hereby presents for filing against the above estate this statement of claim and alleges: 1.) The basis of the claim is: ________________________________________________________________________ GREETINGS: _______________________________________________________________________________________________ _______________________________________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before 2.) The the Honorable name and address of claimant is: ______________________________________________________________ , at the Court located at County_______________________________________________________________________________________________ of in room , on the day of , 20 , at o'clock in the noon, and at any recessed _______________________________________________________________________________________________ or adjourned date, to testify and give evidence as a witness in this action on the part of the 3.) The amount of the claim is $ _____________________________________________________________________ which amount is now due and owing, or, if not due, will become due on___________________________, 20_____. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 4.) The claim behalf this contingent. If contingent, the nature of the contingency is: __________________________ the party on whose (is) (is not) subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. _______________________________________________________________________________________________ Witness, Honorable , one of the Justices of the _______________________________________________________________________________________________ Court in County, day of , 20 Under the penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my (Attorney must sign above and type name below) knowledge and belief. Executed this ______________ day of ______________________, 20 _____. 5.) The claim (is) (is not) secured. If secured, the security consists of: ______________________________________ Attorney(s) for __________________________________________________ Claimant COPY MAILED TO ATTORNEY OF RECORD Office and P.O. Address on _______________________________, 20_____. CLERK OF THE CIRCUIT COURT By_______________________________________ MUST BE FILED IN DUPLICATE. Telephone No.: Facsimile No.: E-Mail Address: SEE REVERSE SIDE FOR IMPORTANT INFORMATION. Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com Revised: 09/12/2002 COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. INSTRUCTIONS Plaintiff(s) : JUDICIAL SUBPOENA -against1.) Inapplicable words or statements may be stricken, but all:information indicated in the form must be given. The nature and extent of the claim should be stated in the spaces provided if sufficient detail to advise the personal representative of the estate of full particulars in order that:the validity of the claim may be determined. 2.) An exact copy of this claim must be filed with the Clerk of the Court at the time of filing. : Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK WARNING TO CLAIMANTS: TO The personal representative of the estate or any party interested in the estate has the right to object to any claim. If objection is filed, suit in a court of competent jurisdiction must be filed within the time allowed by law, or this claim will be barred. See Section 733.705, Florida Statutes. GREETINGS: WE COMMAND YOU, that all business and excuses expiration of one (1) year from the date the claim is filed Even if the objection is filed, a claim will be barred at the being laid aside, you and each of you attend before if the otherwise disposed Court no proceeding is then pending for the , of, and the Honorable claim has not been paid, settled, or at the enforcement or compulsory payment of it. See Section 733.709, Florida Statutes. located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the 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 result of your failure to comply. Witness, Honorable County, , one of the Justices of the day of , 20 Court in (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com Revised: 09/12/2002