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Employment Records Authorization Form. This is a Kansas form and can be use in 3rd Judicial District (Shawnee County) Local District Court.
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Tags: Employment Records Authorization, Kansas Local District Court, 3rd Judicial District (Shawnee County)
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
EMPLOYMENT RECORDS AUTHORIZATION
:
:
TO:
Plaintiff(s)
-against-
Calendar No.
JUDICIAL SUBPOENA
:
The undersigned hereby authorizes you to forward to the law firm of
:
______________________________________________________________________________
______________________________________________________________________________
any and all records, reports, or other information, to include :wage verification, which they
request, concerning my employment with you, at the latter=s request and expense. The
Defendant(s)
:
. .undersigned .further. states . . . . photostatic. copies. of .this. authorization shall have the full force and
. . . . . . . . . . . . . . . . . . . . that . . . . . . . . . . . . . . . . . . . . . .
effect of the original.
Dated this _________ day of YORK
THE PEOPLE OF THE STATE OF NEW______________________, 20______.
TO
___________________________________
SIGNATURE
Social Security No. _____ - ____ - ______
Date of Birth ____/_____/_____
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
STATE OF ______________________
)
located at
County of
), 20
ss: , at
in room
, on the
day of
o'clock in the
noon, and at any recessed
orCOUNTY date,____________________ as a)witness in this action on the part of the
adjourned OF to testify and give evidence
On this ______ day of ____________________, 20_____, before me, a Notary Public in
and for the county and state aforesaid, appeared _______________________________,
Your failure to comply with same person is punishable as a above instrument and duly
personally known to me to be the this subpoena who executed thecontempt 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
acknowledged the execution of the same.
result of your failure to comply.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on the date last above
Witness, Honorable
, one of the Justices of the
written.
Court in
County,
day of
, 20
____________________________________
(Attorney must
Notary Public sign above and type name below)
My Appointment Expires:
__________________________
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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