COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : : Plaintiff(s) -against- Calendar No. JUDICIAL SUBPOENA : Circuit Court for Case No. : City or County Name :Name VS. Apt. Defendant(s) # :Street Address ...................................................... Street Address City ( State Zip Code ) Area Code Telephone City Apt. # State Zip Code THE PEOPLE OF THE STATE OF NEW YORK Plaintiff ( ) Area Telephone Code Defendant TO CERTIFICATE OF PUBLICATION (DOM REL 75) GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before the Honorable at the Court I HEREBY CERTIFY that I caused the publication of the attached notice one time in the , located at County of of of . in room followingon the , newspaper daygeneral circulation: , at , 20 o'clock in the noon, and at any recessed Name of Newspaper or adjourned date, to testify and give evidence as a witness in this action on the part of the The notice was published on , more than 15 days prior to the date specified in the notice for filing an objection to the Petition for Name Change. 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 Witness, Honorable Court in County, Signature , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attach Notice Here Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: Page 1 E-Mail Address: of 1 Mobile Tel. No.: DR75 - Revised 6 May 2002 American LegalNet, Inc. www.USCourtForms.com