Affidavit For Confidential Address
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Affidavit For Confidential Address Form. This is a Maine form and can be use in District Court Statewide.
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Tags: Affidavit For Confidential Address, PA-015, Maine Statewide, District Court
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
STATE OF MAINE
:DISTRICT COURT
Calendar No.
Location
Plaintiff(s)
-against-
:Docket No.
JUDICIAL SUBPOENA
:
:
Plaintiff
:
v.
AFFIDAVIT FOR
CONFIDENTIAL ADDRESS
Defendant(s)
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (19-A M.R.S.A. § 4008)
(5 M.R.S.A. § 4656)
Defendant
THE PEOPLE OF THE STATE OF NEW YORK
For the protection of the plaintiff, the plaintiff requests the court to keep his/her address
confidential.
TO
The plaintiff's address is:
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 ofThe undersigned plaintiff states under oath that the health, safety or liberty of myself and/or
inmy child(ren) would be jeopardized by disclosure of this information forin the
room
, on the
day of
, 20
, at
o'clock the following reasons:any recessed
noon, and at
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.
Date:
Court in
Witness, Honorable
County,
, one of the Justices of the
day of
, 20
Signature
(Attorney must sign above and type name below)
Personally appeared the above named
and made oath to the truth of the statements in the above affidavit, before me,
and signed
Attorney(s) for
Date:
Clerk / Notary Public / Attorney at Law
Office and P.O. Address
PA-015, Rev. 09/01
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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