COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : ________________________________ Plaintiff(s) Full Name/Prisoner Number -against________________________________ ________________________________ ________________________________ Complete Mailing Address Calendar No. : JUDICIAL SUBPOENA : : : Defendant(s) : . .Petitioner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... IN THE UNITED STATES DISTRICT COURT THE PEOPLE OF THE STATE OF NEW YORK FOR THE DISTRICT OF IDAHO TO _______________________________________ Petitioner, ) ) CASE NO. ______________ GREETINGS: (Full name) ) (to be assigned by the Court upon filing) ) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the ) Court vs. APPLICATION located at County of ) FOR IN FORMA in room , on the day of , 20 ) , at o'clock in the noon, and at any recessed PAUPERIS STATUS or adjourned date, to testify and give evidence as a witness in this action on the part of the _______________________________________ ) Respondent. Your failure to comply with this subpoena is punishable aspauperis status rather and will make you liable to By completing this Application, I am requesting in forma a contempt of court than paying the the party on whose behalf this subpoena wasthat, if my request is granted, myof $50 and all damages but I filing fee at the time of filing. I understand issued for a maximum penalty fee will not be waived, sustained as a result of your failure to comply. will be responsible to pay the fee from my prison trust account in increments, when and as I am able to do so. Witness, Honorable Court in County, 1. , one of the Justices of the day of , 20 Are you employed? Yes ____ No. _____. If employed, please state your job title and the total amount of wages you make per month. _______________________________________ Job Title 2. (Attorney must sign above and type name below) $__________ per month Attorney(s) for Within the past twelve (12) months, have you received any money from any of the following sources? a. Business, or other form of self-employment? Yes___ No___ b. Rent payments, interest or dividends? Office and Yes___ No___ P.O. Address c. Pensions, annuities, or life insurance payments: Yes___ No___ d. Gifts or inheritances? Yes___ No___ e. Any other sources? ______________________ Yes___ No___ Telephone No.: Facsimile No.: (State source) E-Mail Address: Mobile Tel. No.: IN FORMA PAUPERIS AFFIDAVIT HABEAS (Rev. 11/02) American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Plaintiff(s) Calendar No. : JUDICIAL SUBPOENA If the answer to any of the above is “yes,” describe each source of money and state the amount -against: received from each during the past twelve (12) months. ________________________________________________________________________ : ________________________________________________________________________ : 3. Do you have any money, including in prison accounts or other checking or savings accounts? Defendant(s) : . . . . . . . . Yes___. . . . . . . No___.. . . . . . . . . . . . . . . . . . . . . . . . . . . ...... ...... If the answer is “yes,” state the total amount. $___________ THE PEOPLE OF THE STATE OF NEW YORK 4. TO Do you own or have any interest in any real estate, stocks, bonds, notes, automobiles or other valuable property (excluding ordinary household furnishings and clothing)? Yes____ No____. If the answer is “yes,” describe the property and state its approximate value. GREETINGS: ________________________________________________________________ ________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County ofList the persons who are dependent upon your support, state your relationship to those 5. in room persons, ,and the on indicate how of day much you do,,or are obligated too'clock in the 20 , at contribute, towardnoon, and at any recessed their support. 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 punishabletrue and correct. court and will make you liable to I declare under penalty of perjury that the foregoing is as a contempt of 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. Executed on this ____ day of _______________________, 20___. Witness, Honorable Court in County, , one of the Justices of the day of ___________________________ , 20 Petitioner (Attorney must sign above and type name below) Note: You do not need to send a copy of this document to Respondent. This Application must be accompanied by a Prison Trust Account Statement. This Application takes the place of an in forma pauperis motion and affidavit. Notarization isAttorney(s) for because the Application not necessary is signed under penalty of perjury. Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: IN FORMA PAUPERIS AFFIDAVIT HABEAS (Rev. 11/02) 2 American LegalNet, Inc. www.USCourtForms.com