COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. REGISTRATION STATEMENT : Initiating IV-D Case No. Calendar No. Responding IV-D Case No. Responding Docket No. : Initiating Docket No. JUDICIAL SUBPOENA Plaintiff(s) I. Case Summary (Background of this Matter: Court/Administrative Actions) -against: State of Support Order State and County Issuing Order Tribunal Case No. : Support Amount/Frequency Computation Date of Last Payment Amount of Arrears : / II. Mother Information Obligor Obligee Defendant(s) : Name .and .Aliases (First, Middle,. Last) . . . . . . . . . . . .Address.(Street, . . . .State, Zip) ....... .. ............. ... . . . . . . . . . City, Period of Computation thru Employer (Name, Street, city, State, Zip). SSN: III. Father Information Obligor THE PEOPLE OF THE STATE OF NEW YORK Obligee Address (Street, City, State, Zip) Name and Aliases (First, Middle, Last) Employer (Name, Street, city, State, Zip). TOSSN: IV. Caretaker (If Not a Parent) Relationship to Child(ren) Name and Aliases (First, Middle, Last) Address (Street, City, State, Zip) GREETINGS: SSN: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court V. Additional Case Information located at County Order is registered in the following states: This 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 Description and location of any property not exempt from execution: Other: 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. VI. Verification/Certification Under penalties of perjury, all information and facts concerning the arrearage accrued under this order are true to the best of my knowledge Witness, Honorable , one of the Justices of the and belief. Court in County, Date day of , 20 Party seeking Registration Records Custodian (Attorney must sign above and type name below) Sworn to and Signed Before Me this Date, County/State Notary Public, Court/Agency Official and title Attorney(s) for Commission Expires Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Registration Statement OMB No. 0970 - 0085 American LegalNet, Inc. www.USCourtForms.com Page 1 of 1