COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Plaintiff(s) -against- Calendar No. : JUDICIAL SUBPOENA : ¨ CIRCUIT COURT ¨ DISTRICT COURT OF MARYLAND FOR................................................ : City/County Located at ......................................................................... Case No. ............................................... Court Address : vs. In the matter of ..................................................... ................................................................ Defendant Defendant(s) : ...................................................... PETITION FOR WAIVER OF COSTS The Petitioner hereby applies for a Waiver of Costs and represents that the answers to the following questions are true. (a) Do THE STATE OF NEW YORK THE PEOPLE OFyou have any money?..................................... How much? ..................................... Where? ............................. (b) Are you employed?................................ Where? ..................................................................................................... (c) Are you self-employed? ......................... Doing what? ............................................................................................. TO Position.................................................................................................................................................................... (d) What is your rate of pay? ........................................................................................................................................... (e) GREETINGS: Do you own an automobile?.................................. Make.............................................................. Year ................... Is it paid for?............................ How much do you owe? ................................. To whom? ....................................... WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Where is the car?....................................................................................................................................................... , the Honorable at the Court (f) Do you owe any money to others? ..................... How much?......................................... To whom?......................... located at County of estate? in room (g) Do you own any realday of ................... Value................................. Where............................................................ , on the , 20 , at o'clock in the noon, and at any recessed (h) date,you testify and give evidence as a witness in this action onWhat?............................................................ Do to own any other property of any kind? ...................................... the part of the or adjourned (i) Does anyone owe you money? ............... If so, state name, address, and amount ....................................................... ................................................................................................................................................................................. (j) failure to comply with this other source, including disability benefits, investments?........................................ Your Do you receive money from anysubpoena is punishable as a contempt of court and will make you liable to If so, behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as the party on whose how much.........................................................................................................................................................a result of your failure to comply.name and address of your wife/husband...................................................................................... (k) If married, give the ................................................................................................................................................................................. Witness, Honorable , one of the Justices of the Does your wife/husband work? .............. Where? ..................................................................................................... Court in County, day of , 20 ........................................................................................................................ Rate of Pay? .................................... (l) Do you have any children?.................................... Names, ages, and addresses:....................................................... ................................................................................................................................................................................. (Attorney must sign above and type name below) ................................................................................................................................................................................. Could they contribute to your assistance now?.......................................................................................................... (m) What is your home address? ...........................................................................................Telephone ......................... Attorney(s) for The Petitioner further represents being without funds and unable to obtain any funds whatsoever from anyone, including family and associates, to pay for: o Counsel o Payment of the fine o Appeal expenses o Civil filing fee or other court costs. I solemnly affirm under the penalties of perjury that the contents of the foregoing document are true and correct. Office and P.O. Address ..................................................................................... Petitioner ORDER Telephone No.: o Approved o Denied Facsimile No.: E-Mail Address: ........................................................................................... ................................................................ Judge/Clerk of Circuit Court Date Mobile Tel. No.: CC-DC 8 (Rev. 5/2003) American LegalNet, Inc. www.USCourtForms.com