STATE OF INDIANA COUNTY OF ALLEN ) ) SS: ) IN THE ALLEN SUPERIOR COURT SMALL CLAIMS DIVISION FORT WAYNE, INDIANA __________________________________________________ CASE NUMBER: 02D01 - __________ - SC - ____________ __________________________________________________ Vs. Plaintiff(s) __________________________________________________ SUBPOENA __________________________________________________ Defendant(s) TO: You are hereby commanded to appear on _______________________________________________ at __________ o'clock _____.M. in the Courthouse Annex, 113 West Berry Street, Fort Wayne, Indiana, 46802, in Allen County, Indiana, for this case. Bring the following with you to the hearing: (STRIKE OUT IF NOT APPLICABLE) _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Dated: ___________________________________________ __________________________________ (______________) Attorney / Party Preparing Subpoena _________________________________________________ CLERK OF ALLEN CIRCUIT AND SUPERIOR COURTS (Seal) or ATTORNEY AS OFFICER OF THE COURT (Party Represented) __________________________________________________ Street Address __________________________________________________ City, State Zip Code __________________________________________________ Telephone Number Supreme Court ID Number MANNER OF SERVICE SHERIFF shall serve this Subpoena as follows: OTHER manner of service: ______ ______ ______ attorney to serve ______ private process server, __________________________________ ______ other (describe in particular and note Trial Rule) personal service leaving a copy at dwelling or place of employment CLERK shall serve this Subpoena as follows: ______ ______ ______ regular mail certified mail publication _____________________________________________________________ CERTIFICATE OF SERVICE BY REGULAR MAIL I hereby certify a copy of this document was sent by U.S. mail as designated above, to the named person, at the address furnished, at Fort Wayne, Indiana. Date: _____________________________________________ 07/2007 Subpoena CLK 054 _________________________________________________ Clerk of the Allen Circuit and Superior Courts American LegalNet, Inc. www.FormsWorkFlow.com CERTIFIED MAIL I hereby certify, as indicated in the date issued field, that a copy of this document was sent to the named person at the address furnished, by registered / certified mail at Fort Wayne, Indiana, return receipt requested. I hereby certify that service by registered / certified mail at Fort Wayne, Indiana, was attempted as required by law to the person and address stated on the return receipt attached; and that service [ ] was [ ] was not made, according to the information contained therein. Date Issued: _________________________ Date Returned: ________________________ _____________________________________________________________ Clerk of the Allen Circuit and Superior Courts _____________________________________________________________ Clerk of the Allen Circuit and Superior Courts ADMISSION OF SERVICE I received a copy of this document on this date ______________________________ and at this location: _____________________________________________ ______________________________________________________________. _____________________________________________________________ Signature of Party Relationship (if not the within named person) RETURN OF SERVICE BY SHERIFF OR OTHER OFFICER Enter the alphabetical letter in the space provided to indicate the type of service. I served a copy of this document as specified: ( __________ ) READING/delivering a copy (A) to the within named party: LEAVING A COPY for the within named party (B) with the SPOUSE, named: (C) with a RELATIVE, named: (D) at the RESIDENCE, located at: (E) with the EMPLOYER, named: (F) with a SECRETARY, named: (G) with the ATTORNEY, named: (H) with this person (OTHER - specify): ______________________________________________________________ Specify name of person, work supervisor, place of business, or location where copy was left. _____________________________________________________________________________________________________ and (if applicable) by sending a copy of this document by first-class mail to the last known address of the within named person as indicated: _____________________________________________________________________________________________________________________________. Last Known Address of Person Named in the document (or Change of Address) I did not serve a copy of this document because: ( __________ ) (I) (J) (K) (L) (M) (N) (O) (P) (Q) the party was NOT FOUND / NO SUCH ADDRESS. the document EXPIRED. the party AVOIDED service. the party REFUSED service. the party was NO LONGER EMPLOYED at that address. the document was RETURNED by the authority of the plaintiff. the party is DECEASED. the party was UNKNOWN AT THAT ADDRESS. the party was on SICK LEAVE / LAY OFF. (R) (S) (T) (U) (V) (W) (X) (Y) the party was on VACATION. the party was NOT FOUND / VACANT. the party was NOT FOUND / MOVED. the party was NOT FOUND IN THIS BAILIWICK. INSUFFICIENT ADDRESS OR INFORMATION WAS GIVEN. they are NO LONGER IN BUSINESS. several attempts were made / UNABLE TO SERVE. of the following reason (OTHER - specify): _____________________________________________________________ I affirm, under the penalty of perjury, that the foregoing representations are true. _____________________________________________________________ Date Served / Attempted Time Served / Attempted _____________________________________________________________ Signature of Sheriff of Allen County, Indiana (or other Officer) _____________________________________________________________ (Printed Name of Process Server) By: _________________________________________________________ (Signature of Process Server) 07/2007 Return of Service American LegalNet, Inc. www.FormsWorkFlow.com