COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : -against- Index No. Calendar No. : United States District Court JUDICIAL SUBPOENA Plaintiff(s) Southern District of Iowa : Credit Card Authorization Form : INSTR UC TIO NS: Please type or print. Mail completed and signed form to: U.S. District Court, P. O. Box 9344, Des Moines, IA 50306-9344. : Defendant(s) : . . . . . Firm ./.Company: . . . . . . . . . . . ______________________________________________ .... ......... ....................... Phone number: ___________________________ THE PEOPLE OF THE STATE OF NEW YORK MasterCard Credit Card Type: VISA TO Card Holder Name: Credit Card Number: GREETINGS: Expiration Date: Discover Am erican Express ______________________________________________ __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ __ __ / __ __ (MM/YY) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Credit Card Statement ______________________________________________ , the Honorable at the Court Mailing Address: (Street address or P.O. Box) located at County of (Please be sure to list the in room , on the day of , 20 , at o'clock in the noon, and at any recessed add ress _______________________, __ __ Zip: of the or adjourned that the credit and give evidence as a witness in this action on the part__ __ __ __ __ date, to testify card company is sending your statem ents to.) (City, State & Zip) 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 I acknowledge that the above information is accurate and that I am an authorized signer result of your failure to comply. of the account. I hereby authorize the United States District Court for the Southern District of Iowa to charge the above credit card account court filing fees incurred by our , one of the Justices of the firmWitness, Honorable or company. Court in Date: County, day of , 20 (Attorney must sign above and type name below) __________________________________ Signature __________________________________ Attorney(s) for Print Name Office and P.O. Address This form , which w ill be kept on file in the Clerk’s Office, shall remain in effect until specifically revoked in w riting. It is the responsibility of the attorney/firm n amed above to no tify the Clerk ’s Office of the new expiration date when a credit card has been renewed, or if a card has been Telephone No.: canceled or revoked. Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com