STATE OF INDIANA COUNTY OF HAMILTON ) ) SS: ) HAMILTON SUPERIOR COURT NO. 4 CAUSE NO. 29D04-________-SC-___________ _______________________________, Plaintiff(s) vs. _______________________________, _______________________________, Defendant(s). VERIFIED MOTION FOR PROCEEDINGS SUPPLEMENTAL AND ORDER TO APPEAR Plaintiff states the following: that Plaintiff owns the judgment rendered in this cause against the Defendant(s); Plaintiff=s judgment is unsatisfied; and Plaintiff has no cause to believe that levy of execution against the Defendant(s) will satisfy the judgment. Plaintiff therefore moves the Court to issue an order to Defendant(s) requiring the Defendant(s) to appear to testify concerning his/her/their property. I swear or affirm under the penalties for perjury that the foregoing representations are true. Dated: __________________, 200__ _____________________________________ Signature of Plaintiff or Attorney ORDER TO APPEAR IN COURT The Court grants the Plaintiff=s motion for proceedings supplemental. The Court ORDERS the Defendant(s) ________________________________________________________ to appear in this Court on _______________________, 200__, at ____:____ a.m. and to bring evidence of income and assets. YOU ARE HEREBY NOTIFIED THAT FAILURE TO APPEAR IN COURT MAY RESULT IN YOUR BEING HELD IN CONTEMPT OF COURT AND BEING PUNISHED BY INCARCERATION IN THE COUNTY JAIL FOR A PERIOD NOT TO EXCEED 180 DAYS. Dated: ___________________, 200__ Service requested: G Certified Mail _____________________________________ Judge, Hamilton Superior Court 4 G Sheriff of __________________ County Address(es) of Defendant(s): _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ Distribution: ____ Plaintiff(s) ____ Defendant(s) (Sheriff=s Return of Service on reverse side) SHERIFF=S RETURN OF SERVICE I hereby certify that on the below date: G I served this Order to Appear by delivering a copy to the Defendant. G I served this Order to Appear by leaving a copy: G at the dwelling or usual place of abode of Defendant; G with a person residing therein, namely __________________________________; G and by mailing a copy of the Order to Appear to the Defendant, by first class mail, to the address listed on this Order to Appear (date mailed if different from below:_____________________, 200__). G I was unable to serve this Order to Appear because __________________________________________ _____________________________________________________________________________________. Dated: ________________________, 200__. ___________________________________ Sheriff of _____________________ County By: ________________________________ sc4form.074 (revised October 30, 2003)