Authorization For Release Of Education Records
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Authorization For Release Of Education Records Form. This is a Kansas form and can be use in 3rd Judicial District (Shawnee County) Local District Court.
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Tags: Authorization For Release Of Education Records, Kansas Local District Court, 3rd Judicial District (Shawnee County)
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
AUTHORIZATION FOR RELEASE OF EDUCATION RECORDS
:
:
Plaintiff(s)
TO:
-against-
Calendar No.
JUDICIAL SUBPOENA
:
:
:
This will authorize release to the firm of _______________________________________
Defendant(s)
:
. .______________________________________________________________________________
....................................................
of any and all information in your possession, custody and/or control pertaining to the education
THE PEOPLE OF THE STATE OF NEW YORK
of the undersigned including but not limited to grades, attendance, discipline, extracurricular
TO
activities, athletics, nursing or health records, graduation or certification. Such release of the
foregoing shall be authorized upon presentation of this authorization or any duplicate or
GREETINGS:
photostatic copy thereof.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable this ______ day of __________________________, 20_____.
at the
Court
Dated
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
__________________________________
SIGNATURE
Your failure to comply with this subpoena is punishable Security No. _____ - and will______ liable to
Social as a contempt of court ____ - make you
the party on whose behalf this subpoena was issued for a Date of Birth: _____/_____/_____
maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
STATE OF __________________ )
) ss:
Witness, Honorable
, one of the Justices of the
COUNTY OF ________________ )
Court in
County,
day of
, 20
Subscribed and sworn to before me this ______ day of _____________________,
20_____.
(Attorney must sign above and type name below)
Attorney(s) for
_________________________________
Notary Public
My Appointment Expires: _______________
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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