COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Plaintiff(s) Instruction to Clerk’s Office: -against- Calendar No. : JUDICIAL SUBPOENA : Send the ORIGINAL of this page to the local Child Support Enforcement Office. : DO NOT PLACE THIS DOCUMENT OR A COPY IN THE COURT FILE. FOR USE BY CHILD SUPPORT ENFORCEMENT AND THE FEDERAL CASE REGISTRY : Defendant(s) : . . . . . . . . Please . . . .the .time. to. complete. the .following. . . . . . . . . . . . . . . . . . take . . . . . . . . . . . . . . . . . . . questions and return this form to the court or the child support office in the county where the order was issued. This will help us to quickly process the child OF THE STATE OF NEW YORK THE PEOPLE support payments we receive from the noncustodial parent’s employer. TO 3. Court Case Information: Circuit Court Case #: ________________ Court Order Date: ___________________ Court Order Effective Date: ___________ Court Ordered Amount and Frequency: __________________________________ In which county was the order entered? __________________________________ 1. Custodial Parent Information: Name: ____________________________ Date of Birth: ______________________ 4. Minor Children Included in this Order: SSN: _____________________________ GREETINGS:___________ Race: ____________ a. Name: _________________________ Sex: DOB: _____________ Sex: ________ Mailing Address: WE COMMAND YOU, that all business and excuses being laid _____________ Race: of you attend before SSN: aside, you and each ________ __________________________________ , the Honorable Court b. Name: _________________________ __________________________________ at the DOB: _____________ Sex: ________ City/State/Zip: ______________________ located at County of SSN: _____________ Race: ________ recessed in room Telephone on_______________________ , 20 , #: the day of , at o'clock in the noon, and at any c. Name: the part of the Work #: ___________________________ a witness in this action on_________________________ or adjourned date, to testify and give evidence as DOB: _____________ Sex: ________ SSN: _____________ Race: ________ 2. Non-Custodial Parent Information: d. Name: _________________________ Name: ____________________________ DOB: _____________ Sex: ________ Date of Birth: ______________________ Your failure to comply with this subpoena is punishable as SSN: _____________ and will make you liable to a contempt of court Race: ________ SSN: _____________________________ the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Sex: ___________ Race: ____________ result of your failure to comply. 5. Do you believe that disclosure of your address or Address: __________________________ other identifying information might result in physical City/State/Zip: _____________________ or emotionalone of the Justices of the Employer Honorable Name: ___________________ Witness, , harm to you or your child? Employer Address: _________________ Court in _________________________________ County, day of , 20 ‭ Yes ‭ No Employer Telephone #: ______________ Questions regarding race and sex are used only to make sure we havemust sign above correct person. It has no impact (Attorney identified the and type name below) on how your case is handled. The information you have provided will be sent to the Federal Case Registry, as required by Federal law. The Federal Case Registry is a national database that contains child support information. If you let us know that disclosure of your address or other identifying information might result in physical or emotional harm to you or your child, your file will be givenAttorney(s) for will protect your information. You a special code that may also consider using a Post Office box for your mailing address. Please remember – our ability to quickly process and deliver your support payments depends, in part, on you. We must always have your current mailing address. Office and P.O. Address QUESTIONS? CALL: 1-800-332-6347 Date: ___________________ Page 1 of 1 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Enforcement Addendum to EWO Child Support American LegalNet, Inc. www.USCourtForms.com