COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Plaintiff(s) Calendar No. : JUDICIAL SUBPOENA -against: State of Indiana – County of _______________ : In the _______________________Court : Defendant(s) : . . . . . STATE. OF .INDIANA . . . . . . . . . . . . . . . . . . . ). . . . . . . . . . ...... ... ......... ) v. ) ) THE PEOPLE OF THE STATE OF NEW YORK __________________________________ ) Case No. ______________________ TO DOMESTIC VIOLENCE DETERMINATION GREETINGS: in accordance with I.C. 35-38-1-7.7, having heard evidence at trial, or based on a The Court, factual basis provided as part of a guilty plea in this case now finds that the Defendant has WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before committed a crime of domestic violence, as defined by I.C. 35-41-1-6.3. The Defendant has been advised , the Honorable that upon conviction: he/she shall losethe right to possess a firearm, possession of a at the Court firearm or ammunition may located at a separate crime, parenting time with minor children may constitute County of be in room restricted,, andthe on other legal penalties may be applicable and should be discussed with and at any recessed day of , 20 , at o'clock in the noon, his/her attorney. or adjourned date, to testify and give evidence as a witness in this action on the part of the “Crime of domestic violence,” as defined by I.C. 35-41-1-6.3 means an offense or the attempt to commit an offense that: Your failure as an element the: subpoena is punishable as a contempt of court and will make you liable to (1) has to comply with this the party on whose behalfuse of physical force; or for a maximum penalty of $50 and all damages sustained as a (A) this subpoena was issued result of your failure to comply. (B) threatened use of a deadly weapon; and (2) is committed against a: (A) current or former spouse, parent, or guardian of the, defendant; Justices of the Witness, Honorable one of the (B) person with whom the defendant shared a child in common; Court in County, day of , 20 (C) person who was cohabiting with or had cohabited with the defendant as a spouse, parent, or guardian; or (D) person who was or had been similarly situated to a spouse, parent, or (Attorney must sign above and type name below) guardian of the defendant. The Defendant was represented by counsel or made a valid waiver of counsel. The Defendant was advised of his/her right to a jury trial and either received a jury trial or knowingly waived that Attorney(s) for right. ____________________________ Date Distribution: Prosecuting Attorney Case file Defendant ______________________________ Office Judge and P.O. Address Telephone No.:Form: DV-001 Facsimile No.: July, 2003 E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com