COURT COUNTY .OF. . . . . . . . . Child. Support. . . . . . . . .Transmittal Form ......... .. . . . . . . . . . . . . . . Order . . . . . . . . . : Index No. This form is to be completed and given to the Clerk of the Court, with a copy of the order attached. : Calendar No. CHILD SUPPORT PAYMENTS MUST BE MADE PAYABLE TO THE : DEPARTMENT Plaintiff(s) AND WELFARE OF HEAL TH JUDICIAL SUBPOENA AND SENT TO -against: CHILD SUPPORT RECEIPTING, P.O. BOX 70008, BOISE, ID, 83707 : Case # ___________________ County ______________________ Date of Order _________________________ : Plaintiff's full name ____________________________________________________________ ( ) male ( ) female Defendant(s) : ...... ...................... ... . .... ....... Social .Security .#. ______________________ . . . . .Date. of. Birth .____________ Phone number _______________ Mailing Address ______________________________________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK Residence address (if different than mailing) ________________________________________________________ TO Employer Name and Address ____________________________________________________________________ Plaintiffs Attorney: _____________________________ Phone _________________ City/State _____________ GREETINGS: Defendant's full name __________________________________________________________ ( ) male ( ) female WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable Court Social Security # ______________________ Date ofat the ____________ Phone number _______________ Birth located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed Mailing Address ______________________________________________________________________________ or adjourned date, to testify and give evidence as a witness in this action on the part of the Residence address (if different than mailing) ________________________________________________________ Employer Name and Address ____________________________________________________________________ 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 Defendant's Attorney: _____________________________ Phone _________________City/State _____________ result of your failure to comply. Children for whom support is ordered in this order: Witness, Name Child's FullHonorable Court in County, day of Social Security # _______________________________________________________ ____________________ _______________________________________________________ _______________________________________________________ ____________________ _______________ ________ (Attorney must sign above and type name below) ____________________ _______________ ________ _______________________________________________________ ____________________ _______________________________________________________ ____________________ , one of the Justices of the Date of Birth Sex , 20 _______________ ________ _______________ ________ _______________ ________ _______________________________________________________ ____________________ _______________ If support is ordered for more than six children, please attach a separate sheet of paper with the information. ________ Is there an Income Withholding Order? ( )Yes ( ) No Attorney(s) for Office and P.O. Address (If yes, please attach a copy) Print name of person who completed this form: ______________________________________ Phone ____________________ Telephone No.: Clerk: Send transmittal form and order copy to: State Case Registry, ATTN: Facsimile No.: Box 83720, Boise ID 83720-0036 Linda Jolly, PO E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com