COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. IN THE DISTRICT COURT OF SHAWNEE :COUNTY, KANSAS JUDICIAL SUBPOENA Plaintiff(s) -against- : ) ___________________________________ ) : Plaintiff / Petitioner ) ) : and / vs. ) Case No. _____________________ ) Defendant(s) : ............................. . __________________________________ . . . . . ) . . . . . . . . . . . . . . . . . . . Defendant / Respondent ) _______________________________________) THE PEOPLE OF THE STATE OF NEW YORK DOMESTIC RELATIONS AFFIDAVIT OF __________________________ TO 1. 2. Petitioner's ___________________ Date of Birth GREETINGS: Current Address: _______________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before ___________________________________________________________________________ , the Honorable at the Court located at County of _______________________________ noon, and at any recessed inRespondent's ___________________ room , on the day of , 20 , at o'clock in the Date of Birth give evidence as aSocial Security Numberon the part of the or adjourned date, to testify and witness in this action Current Address: 3. 4. _______________________________ Social Security Number ________________________________________________________ ____________________________________________________________________________ make you liable to Your failure to comply with this subpoena is punishable as a contempt of court and will the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Date of Marriage ________________________________ Number Witness, Honorable of Marriages _________________ Petitioner day of Court in County, _______________ one of the Justices of the , Respondent , 20 5. Number of Children of this marriage or relationship: __________ 6. (Attorney must sign above and relationship: Names, Social Security Numbers, birthdays, and ages of minor children of this marriage ortype name below) Name ________________________ Social Security No. _____________________ Date of Birth _______________ Attorney(s) for Age _______ ________________________ _____________________ _______________ _______ ________________________ _____________________ _______________ _______ ________________________ _____________________ _______________ Office and P.O. Address _______ ________________________ _____________________ _______________ _______ Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT 7. Names, Social Security numbers, and ages of minor children you are obligated to support arising out of other COUNTY .OFand facts . . .to . . . . . . . and. support . . . . . . . . paid. or. received, if any: marriages or .relationships. . . . . . . . as . custody . . . . . . . . payments . . . . . . ....... . : Index No. Name of Name of Social Date of Support Paid : or Calendar No. Child(ren) Residential Security Birth Received Custodian Number : _________________ _______________ ________________ ________ JUDICIAL SUBPOENA ___________ Plaintiff(s) _________________ _______________ -against- ________________ ________ : ___________ _________________ _______________ ________ : ___________ 8. ________________ Petitioner is employed by _________________________________________ : (Name) Defendant(s) __________________________________________ : ...................................................... (Address of Employer) Respondent is employed by __________________________________________ (Name) __________________________________________ THE PEOPLE OF THE STATE OF NEW YORK (Address of Employer) TO with monthly income as follows: A. Wage Earner Petitioner Respondent GREETINGS: 1. Gross $__________ $__________ 2. WEOther Income YOU, that all business and excuses being laid aside, you and each of you attend before $__________ $__________ COMMAND 3. Subtotal Gross Income $__________ $__________ , the Honorable at the Court 4. of Federal Withholding located at $__________ $__________ County 5. Federal Income Tax day of in room , on the , 20 , at$__________ in the $__________at any recessed o'clock noon, and 6. OASDHI $__________ or adjourned date, to testify and give evidence as a witness in this action on the part of $__________ the 7. Kansas Withholding $__________ $__________ 8. Subtotal Deductions $__________ $__________ 9. Net Income $__________ $__________ 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 (Line A.3. minus Line A.8.) result of your failure to comply. B. Self-Employed Witness, Honorable , one of the Justices of the 1. Gross Income from self-employ $___________ $___________ Court in County, day of , 20 2. Other Income $___________ $___________ 3. Subtotal Gross Income $___________ $___________ 4. Reasonable Business Expenses $___________ $___________ (Attorney must sign above and type name below) (Itemize on attached exhibit) 5. Self-Employment Tax $___________ $___________ 6. Estimated Tax Payments $___________ $___________ (Claim ____ Exemptions) Attorney(s) for 7. Federal Income Tax $___________ $___________ 8. Kansas Withholding $___________ $___________ 9. Subtotal Deductions $___________ $___________ 10. Net Income $___________ $___________ Office and P.O. Address (Line 18.C minus Line 18-I) Pay period: 9. ___________________ Petitioner _____________________ Telephone No.: Respondent Facsimile No.: E-Mail Address: Work related Child Care Expenses: Weekly expenses: Name and address of provider Mobile Tel. No.: $___________________ ______________________________________________________ LegalNet, Inc. American www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index 10. Health Insurance provided by: _____ Petitioner_____ Respondent No. Family Coverage Yes ______ No :_____Calendar No. Name of health insurance plan: : JUDICIAL SUBPOENA Plaintiff(s) ________________________________________________________________________ -against: Persons insured on family plan: ______________________________________________ : ________________________________________________________________________ : What is the increased cost for providing the family plan health insurance over the cost of the single plan Defendant(s) coverage? $__________ per _________. Amount of annual :deductible __________%; coinsurance. ...................................................... Sections 11 thru 13 need not be completed in post-judgment motions to modify child support. 11. The assets of OF THE are: THE PEOPLE the partiesSTATE OF NEW YORK Ownership Joint or Individual TO Date Acquired Fair Market Value Date of Valuation Asset and Ownership GREETINGS: A. Checking Accounts: WE COMMAND YOU, that all business_________ being laid aside, you and each of you attend before and excuses $_________ ________________________ _________ ____________ , the Honorable at the Court ________________________ located at _________ _________ $_________ ____________ County of inB. room Savings Accounts and Certificates of Deposit: , 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 ________________________ _________ _________ $_________ ____________ ________________________ _________ _________ $_________ ____________ C. Cash on Hand: 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 ________________________ _________ _________ $__________ ____________ result of your failure to comply. ________________________ _________ _________ $__________ ____________ Witness, Honorable , BE ANSWERED of the *** PARAGRAPHS 12 D. THROUGH 12 J., 13, 14, 15 AND 16 NEED NOTone of the JusticesIN POSTCourt in County, day of , 20 JUDGMENT PROCEEDINGS. *** D. Employer Retirement/Savings/Pension Plans (401K, Pensions, Profit Sharing, etc.): ________________________ _________ _________ (Attorney must sign above and type name below) $__________ ___________ ________________________ _________ _________ E. Real Estate: $__________ Attorney(s) for ________________________ _________ _________ ________________________ _________ ________________________ _________ _________ ________________________ _________ County Appraiser Value _________ F. $__________ ___________ ___________ $__________ ___________ Office and P.O. Address Stocks, Bonds, Mutual Funds, and Other Marketable Securities: ________________________ _________ $__________ ___________ Telephone No.: _________ $__________ ___________ Facsimile No.: E-Mail Address: _________ Mobile Tel. No.: ___________ $__________ ________________________ _________ _________ G. Money Owed to You: $__________ ___________ American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. H. Life Insurance: Cash Value : Calendar No. _______________________ _________ _________ $__________ ___________ _______________________ I _________ Plaintiff(s) _________ :$__________ ___________ JUDICIAL SUBPOENA :Fair Market Value Make/Model/VIN# : _______________________ _________ _________ $__________ : _______________________ _________ _________ $__________ Defendant(s) :$__________ . ._______________________. . . ._________. . . . ._________. . . . . ...................... ........ ........ J. Automobiles and Motorcycles: -against- ___________ ___________ ___________ Miscellaneous Personal Property: Boats, Trailers or Campers: THE PEOPLE OF THE STATE OF NEW YORK _______________________ _________ _________ $__________ ___________ TO _______________________ $__________ ___________ _________ _________ Hand or Power Tools: ______________________ _________ _________ $__________ ___________ GREETINGS: ______________________ _________ _________ $__________ ___________ Jewelry:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court ______________________ _________ _________ $__________ ___________ located at County of in______________________ day of room , on the , 20 , at o'clock in ___________ at any recessed noon, and _________ _________ $__________ the or adjourned date, to testify and give evidence as a witness in this action on the part of the Guns: ______________________ _________ _________ $__________ ___________ ______________________ _________ _________ $__________ court and will Your failure to comply with this subpoena is punishable as a contempt of ___________ 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 Camera Equipment: result of your failure to comply. ______________________ _________ _________ $__________ ___________ Witness, Honorable , one ___________ ______________________ _________ _________ $__________ of the Justices of the Court in County, day of , 20 Antiques: ______________________ _________ _________ $__________ ___________ ______________________ _________ _________ (Attorney must sign above and type name below) $__________ ___________ Personal Injury or Worker's Comp. Claims: ______________________ _________ _________ Attorney(s) for $__________ ___________ ______________________ _________ _________ ___________ K. $__________ All Other Assets not Included Above: ______________________ _________ _________ Office and P.O. Address $__________ ___________ ______________________ _________ _________ TOTAL $__________ ___________ Telephone No.: Facsimile No.: $________________ E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. 12. List all liabilities of the parties: Include mortgages and indebtedness to banks, individuals, loan companies or : Calendar No. on credit accounts. Indicate actual balance due as of the date this document is prepared. If secured, state the property which secures the loan. : JUDICIAL SUBPOENA Plaintiff(s) Creditor Balance Owed Amount of Monthly Security -against: Payment / Amount : ______________________ _____________ ________________ __________________ : ______________________ _____________ ________________ __________________ ______________________ _____________ Defendant(s) ________________ : ...................................................... ______________________ _____________ ________________ __________________ ______________________ ________________ __________________ THE PEOPLE OF THE _____________ ______________________ STATE OF NEW YORK ________________ __________________ 13. TO _____________ __________________ Recapulation: Assets A. GREETINGS: B. Checking Accounts $_______________________ Savings Accounts $_______________________ C. Cash $_______________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable Retirement Plans at the $_______________________ Court D. located at County of Real Estate in room E. , on the day of , 20 $_______________________ noon, and at any recessed , at o'clock in the or adjourned date,Marketable Securities to testify and give evidence as a witness$_______________________ in this action on the part of the F. G. Accounts Receivable $_______________________ H. Life Insurance $_______________________ 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 $_______________________ all damages sustained as a maximum penalty of $50 and I. Misc. Personal Property result of your failure to comply. Total Value of Assets $_______________________ Witness, Honorable Court in Liabilities County, , one of the Justices of the day of , 20 A. Real Estate Mortgage $______________________ B. Auto Loans $______________________ type name below) (Attorney must sign above and C. Total Other Debts $______________________ Total Liabilities $______________________ Attorney(s) for Parties Net Worth $______________________ (Assets Minus Liabilities) Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. This section to be completed only if requesting temporary support or requesting adjustment in guideline amounts for : Calendar No. hardship reasons. 14 : JUDICIAL SUBPOENA Plaintiff(s) Petitioner Respondent : (Actual or Estimated) (Actual or Estimated) : House payment, rent or mortgage $________________ $_______________ : Food $________________ $_______________ The monthly expenses of each party are: -againstItem A. B. Defendant(s) C. Utilities: : ...................................................... Trash Service $________________ Newspaper $_______________ $________________ $_______________ THE PEOPLE OF THE STATE OF NEW YORK $________________ Telephone $_______________ Gas and Lights $________________ $_______________ Water $________________ $_______________ Cable $________________ $_______________ GREETINGS: Other $________________ $_______________ TO D. Insurance: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court Life $________________ $_______________ located at County of $________________ $_______________ and at any recessed in room Health , on the day of , 20 , at o'clock in the noon, or adjourned date, to testify and give evidence as a$________________ on the part of the witness in this action $_______________ Car House $________________ $_______________ Other $________________ $_______________ 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 E. Uninsured Health $________________ $_______________ result of your failure to comply. F. Child Care (Babysitting) $________________ $_______________ G. Clothing Honorable Witness, Court in School Expenses County, H. $________________ day of $_______________ of the , one of the Justices , 20 $________________ $_______________ $_______________ I. Hair Cuts and Beauty $________________ J. Car Repair $________________ must sign above and type name below) $_______________ (Attorney K. Gas and Oil $________________ L. Personal Property Tax $________________ $_______________ Attorney(s) for M. Miscellaneous (specify) $_______________ Recreation $________________ ________________________ $________________ $_______________ Office and P.O. Address $________________ $_______________ ________________________ $_______________ ________________________ $________________ $_______________ Telephone No.: TOTAL MONTHLY EXPENSES $________________ $_______________ Facsimile No.: (Please indicate an asterisk all figures which are estimates rather E-Mail Address: taken from records.) than actual figures Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar No. I have read the above affidavit and to the best of my knowledge believe that the information is accurate and complete. Plaintiff(s) -against- : JUDICIAL SUBPOENA : ___________________________________ : (Signature of Petitioner/Respondent) : SUBSCRIBED AND SWORN TO before me this _____ day of _______________, _______. Defendant(s) : ...................................................... ___________________________________ NOTARY PUBLIC/DEPUTY CLERK My appointment expires:_______________ THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court 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 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 result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com