COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : : Plaintiff(s) Calendar No. JUDICIAL SUBPOENA IN THE DIS TRICT COURT OF DOUGLAS COUNTY, KANS AS -against: : In the M atter of: ) : ) , ) Case No. DG Defendant(s) : and . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) . . . . . . Division. 3 . ........ ....... . ) . ) ____________________________________) THE PEOPLE OF THE STATE Pursuant to K.S.A. Chapter 60. OF NEW YORK TO DOMES TIC RELATIONS AFFIDAVIT OF GREETINGS: 1. 2. Petitioner’s Residence______________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Petitioner’s ___________ ______________________ ________________ , the Honorable Date of Birth at the Court Social Security Number Home Telephone located at County of inRespondent’s Residence______________________________________________________________ recessed room , on the day of , 20 , at o'clock in the noon, and at any orRespondent’s to testify and give evidence as a witness in this action on the part of the adjourned date, ____________ ______________________ _________________ Date of Birth 3. 4. 5. 6. Social Security Number Home Telephone Date of Marriage: _______________ 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 ______________ of $50 and all damages sustained as a maximum penalty Number of Marriages: _______________ Petitioner Respondent result of your failure to comply. Number of children of marriage: ____________ Witness, Honorable , one of the Justices of the Court in County, day of , 20 Names, Social Security numbers, birth dates, and ages of minor children of the marriage: Name __________________ __________________ __________________ __________________ Social Security No. ___________________ ___________________ ___________________ ___________________ Date of Birth Age Custodian _____________ _____ _________ (Attorney must sign above and type name below) _____________ _____ _________ _____________ _____ _________ _____________ _____ _________ Attorney(s) for 7. Names, Social Security numbers, and ages of minor children as to custody and support payments paid or received, if any. Name __________________ __________________ __________________ __________________ Social Sec. No. _______________ _______________ _______________ _______________ of Age Custodian ____ Office and P.O. _________ ____ _________ ____ _________ ____ _________ previous Support Payment $______ Address $______ $______ $______ marriage and facts Paid or Rec’d ________ ________ ________ ________ Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : 8. Index No. : Petitioner is employed by__________________________________________________________ Calendar No. __________________________________________________________ : Respondent is employed by__________________________________________________________ JUDICIAL SUBPOENA Plaintiff(s) __________________________________________________________ -against(Name and address of employer) : with monthly income as follows: A. : Wage Earner Petitioner 1. Gross Income $____________ 2. Other Income $____________ 3. Subtotal Gross Income $____________ Defendant(s) . .4.. . . . . Federal . Withholding:. . . . . . . . . . . . . . . . . . . . . . ....... ........... (Claiming __ exemptions)$____________ 5. Federal Income Tax $____________ 6. OASDHI $____________ 7. Kansas Withholding $____________ 8. Subtotal Deductions THE PEOPLE OF THE STATE OF NEW$____________ YORK 9. Net Income $____________ : : ...... Respondent $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ TO B. Self-Employed Petitioner Respondent 1. Gross Income from selfemployment $____________ $___________ 2. Other Income $____________ $___________ 3. Subtotal Gross Income $____________ $___________ GREETINGS: 4. Reasonable Business Expenses (itemize on WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before attached exhibit) $____________ $___________ the Honorable at the Court 5. Self-Employment Tax $____________ $___________ 6. $____________ $___________ located at County ofEstimated Tax Payments (Claim __ Exemptions) in7. room Federal , Income Tax day of $____________ , at on the , 20 o'clock in the $___________ noon, and at any recessed or8. adjourned date, Withholding give evidence as a witness in this action on the part of the Kansas to testify and $____________ $___________ 9. Subtotal Deductions $____________ $___________ 10. Net Income (Line B.3 minus Line B.9.) $____________ $___________ 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 Pay period: your failure to comply. ______________________ result of ____________________ Petitioner 9. Witness, Honorable Court in County, Respondent The liquid assets of the parties are: A. B. C. D. Item Checking Accounts: _________________ _________________ Savings Accounts: _________________ _________________ Cash (Petitioner) (Respondent) Other _________________ _________________ day of , one of the Justices of the , 20 Joint or Individual (Specify) Amount $______________ ____________________ $______________ ____________________ (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 , COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : 10. Index No. Calendar No. The monthly expenses of each party are: (Please indicate with an asterisk all figures : JUDICIAL SUBPOENA which are estimates rather than actual Plaintiff(s) figures taken from records.) -against- A. : Petitioner (Actual or Estimated) : Respondent (Actual or Estimated) Item : 1. 2. .3.. . Rent (if applicable)* $_______________ $_______________ Food $_______________ $_______________ Defendant(s) : . . . . . Utilities: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......... Trash service $_______________ $_______________ Newspaper $_______________ $_______________ Telephone $_______________ $_______________ Gas $_______________ $_______________ Water $_______________ THE PEOPLE OF THE STATE OF NEW YORK $_______________ Lights $_______________ $_______________ Other $_______________ $_______________ TO 4. Insurance: Life $_______________ $_______________ Health $_______________ $_______________ Car $_______________ $_______________ House/Rental $_______________ $_______________ GREETINGS: Other $_______________ $_______________ 5. Medical and dental $_______________ $_______________ 6. Prescription drugs that all business$_______________ laid aside, you and each of you attend before $_______________ WE COMMAND YOU, and excuses being 7. Child care (work related) $_______________ $_______________ the Honorable care (non-work related) at the 8. Child $_______________ Court $_______________ located at 9. $_______________ $_______________ County ofClothing $_______________ o'clock in the $_______________any recessed in10. room School expenses , on the day of , 20 , at noon, and at 11. Hair cuts and beauty $_______________ $_______________ or12. adjourned date, to testify and give evidence as a$_______________ on the part of the witness in this action Car repair $_______________ 13. Gas and oil $_______________ $_______________ 14. Personal property tax $_______________ $_______________ 15. Miscellaneous (Specify) _______________________ $_______________ Your failure to comply with this subpoena is punishable as a contempt of $_______________ you liable to court and will make _______________________ $_______________ $_______________ the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a _______________________ $_______________ $_______________ 16. Debt Payments (Specify) result of your failure to comply. _______________________ $_______________ $_______________ _______________________ $_______________ $_______________ Witness, Honorable , one of the Justices of the _______________________ $_______________ $_______________ Court in County, Total day of , 20 $_______________ $_______________ (Attorney must sign above *Show house payments, mortgage payments, etc. in Section 10.B and type name below) B. Monthly payments to banks, loan companies or on credit accounts: (Indicate actual Attorney(s) for or estimate, use asterisk for secured.) NOT LIST ANY PAYMENTS INCLUDED IN PART DO 10.A. ABOVE. Amount of Payment/ When Date of Responsibility Creditor Incurred Last Payment Balance Office and Petitioner Respondent P.O. Address _________ ________ _____________ $________ $___________ $___________ _________ ________ _____________ $________ $___________ $___________ _________ ________ _____________ $________ $___________ $___________ _________ ________ _____________ $________ $___________ $___________ Telephone $___________ No.: _________ ________ _____________ $________ $___________ _________ ________ _____________ $________Facsimile No.: $___________ $___________ Subtotal of Payments $___________ $___________ E-Mail Address: Total $___________ $___________ Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com , COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : : Plaintiff(s) C. Total Living Expenses -against- Calendar No. JUDICIAL SUBPOENA : : 1. . 2. 3. .4.. . . Total funds available to Petitioner and Respondent (from No. 8) Total needed (from No. 10, A. and B.) Net balance Defendant(s) .Projected. . . . . . . support . . . . . . . . . . . . . . . . . . . . . . . . . . . . child . . . . . . . : : ...... D. Payments or contributions received, or paid, for support amount. Source Petitioner ______________________ (+/-) $_______________ THE PEOPLE OF THE STATE OF NEW YORK ______________________ (+/-) $_______________ ______________________ (+/-) $_______________ TO ______________________ (+/-) $_______________ 11. Petitioner (Actual or Estimated) Respondent (Actual or Estimated) $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ of others. Specify source and Respondent $_______________ $_______________ $_______________ $_______________ How much does the party who provides health care pay for family coverage? GREETINGS: $___________________ per _____. How much WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend does it cost the provider to furnish health insurance only on the provider? $___________________ per _____. 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 FURNISH THE FOLLOWING INFORMATION IF APPLICABLE. or adjourned date, to testify and give evidence as a witness in this action on the part of the 12. Income and financial resources of children. Income/Resources Amount 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, day of 13. Child support adjustments requested. Long Distance Visitation Costs Visitation Adjustment Income Tax Consideration Special Needs Agreement Past Minority Overall Financial Condition , one of the Justices of the , 20 Petitioner Respondent $_____________ $_____________ $_____________ $_____________ (Attorney must $_____________ sign above and type name below) $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ Attorney(s) for 14. All other personal property including retirement benefits (including but not limited to qualified plans such as profit-sharing, pension, IRA, 401(k), or other savings-type employee benefits, nonqualified plans, and deferred income plans), and ownership thereof (joint or individual), including policies of insurance, identified as to nature or description, ownership (joint or individual), and actual and estimated value. Office or P.O. Address __________________________ __________________________ __________________________ __________________________ Joint or Individual Amount Telephone (Specify) No.: $____________ _________________ Facsimile No.: $____________ _________________ $____________ _________________ E-Mail Address: $____________ _________________ Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. THE FOLLOWING NEED NOT BE FURNISHED IN POST JUDGMENT PROCEDURES . : JUDICIAL SUBPOENA Plaintiff(s) -against15. : List real property identified as to description, ownership (joint or individual) and actual or estimated value. : Property Description Ownership Actual/Estimated Value : _ _ ________________________________________________________________________________________ _ _ ________________________________________________________________________________________ _ _ ________________________________________________________________________________________ Defendant(s) : _ _ ________________________________________________________________________________________ ...................................................... _ _ ________________________________________________________________________________________ _ _ ________________________________________________________________________________________ ___________________________________________________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK 16. Identify the property if any acquired by each of the parties prior to marriage or TO or acquired during marriage by a will or inheritance. Property Description Source of Ownership Ownership Actual/ Estimated Value 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 17. List debt obligations, including maintenance, not listed in Section 10.A. or 10.B. above, identified as to name or names, of obligor or obligors and obligees, balance Your failure to comply with this subpoena is punishable as a contempt of court and will make due and rate at which payable; and, if secured, identify the encumbered property. you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Debt Balance Payment Encumbered result of your failure to comply. Obligation Obligor Obligee Due Rate Property Witness, Honorable , one of the Justices of the _ _ ________________________________________________________________________________________ _ _ ________________________________________________________________________________________ Court in County, day of , 20 _ _ ________________________________________________________________________________________ _ _ ________________________________________________________________________________________ _ _ ________________________________________________________________________________________ ___________________________________________________________________________________________ (Attorney must sign above and type name below) 18. Attorney(s) for List health insurance coverage and the right, pursuant to ERISA Sec. 601-608, 29 Sec. 1161-1168 (1986), to continued coverage by the spouse who is not a member of the covered employee group. Health Insurance COBRA Continuation Office and P.O. Address ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ U.S.C. Yes _____ _____ _____ Telephone No.: _____ Facsimile No.: _____ No _____ _____ _____ _____ _____ Unknown _____ _____ _____ _____ _____ E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com , COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Plaintiff(s) Calendar No. : JUDICIAL SUBPOENA -against) ss. State of : ) County of : ) : I swear or affirm under penalty of perjury that this affidavit and attached schedules are true and complete. Defendant(s) : ...................................................... ___________________________________ (Your signature) THE PEOPLE OF THE STATE OF NEW YORK Subscribed and sworn before me this______ day of ___________, 20 . TO GREETINGS: _______________________________ Notary Public My Appointment Expires: 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