COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Plaintiff(s) -againstCIRCUIT COURT Index No. Calendar No. : : JUDICIAL SUBPOENA DISTRICT COURT OF MARYLAND FOR............................................... : City/County Court Address Located at ...................................................................................Case No.................................................. ...................................................................................... Petitioner vs. ...................................................................................... Respondent : Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .FINANCIAL. STATEMENT .......... .... Person for whom support is needed: Name Birth Date or Age ............................ ............................ ............................ Address ............................................................................... ............................................................................... ............................................................................... MONTHLY EXPENSES: (see below*) Rent/Mortgage................................. $ ......................... Food................................................. $ ......................... THE PEOPLE OF THE STATE OF NEW YORK ................................................................ ................................................................ TO ................................................................ MONTHLY INCOME: My pay before taxes ........................ $ ......................... My pay GREETINGS: after taxes ........................... $ ......................... Other deductions from Transportation.................................. $ ......................... my pay (explain) YOU, that all business and excuses being laid aside, you and each of you ......................... WE COMMAND Light/Gas/Heat ................................ $ attend before the Honorable at the Court ......................................................... $ ......................... Telephone ........................................ $ ......................... , located $ County of .........................................................at ......................... Child Care (during work hours) ...... $ ......................... in room Final amount of my paycheck of , on the day ......... $ ......................... , at , 20 o'clock in the noon, and at any recessed Health Ins. (if children covered)...... $ ......................... or adjourned date, to testify and give evidence as a witness in this action on the part of the (I am paid every week 2 weeks month other.) Court-Ordered Child Support or Alimony.................................. $........... .............. Other (explain)................................. $ ......................... Name of my employer:................................................. Address of my employer: ............................................. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to ...................................................................................... ......................................................... $ sustained as the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages.........................a I have other income as follows (list second job, AFDC, result of your failure to comply. ......................................................... $ ......................... Witness, Honorable ...................................................................................... Court in County, day of , 20 ...................................................................................... ...................................................................................... ...................................................................................... ...................................................................................... ASSETS I own the following items of value, either by myself or with someone else: (List cash, cars, bank accounts, houses, and any other property either owned separately or jointly with another. State how much each is worth.) ......................................................... $ ......................... ......................................................... $ ......................... ......................................................... $ ......................... ..................................................................................... . Date unemployment, court-ordered support, etc. List how much you receive, how often, and who pays it.) ......................................................... $ ......................... , one of the Justices of $ ......................... ......................................................... the ......................................................... $ ......................... ......................................................... $ ......................... (Attorney must sign above and type name below) ......................................................... $ ......................... ......................................................... $ ......................... DEBTS I owe the following amounts to the following Attorney(s) (List the person/company you owe and creditors: for how much is owed.) ......................................................... $ ......................... ......................................................... $ ......................... Office and P.O. Address ......................................................... $ ......................... ......................................................... $ ......................... ...................................................................................... Signature Telephone No.: *Expenses should include expenses for children if they are residing with you. To figure the monthly amount, weekly expenses Facsimile No.: should be multiplied by 4.3 and yearly expenses should be divided E-Mail you do not pay the same amount each month for any by 12. If Address: of the categories listed, figure what your average monthly expense is. Mobile Tel. No.: CC-DC/DV 4 (Rev. 7/2003) American LegalNet, Inc. www.USCourtForms.com