COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. DISTRICT COURT OF MARYLAND FOR .......................................................................................... City/County : Calendar No. Located at........................................................................................ Case No.............................................................. . Court Address : JUDICIAL SUBPOENA Plaintiff(s) CERTIFICATE OF WITNESS COMPENSATION -against- (CJ § 9-202) : This certificate must be obtained by the witness within 30 :days of the last date of attendance. To be completed by witnesses within the State of Maryland only. : G Criminal - payable by the State of Maryland Defendant(s) : ...................................................... G Civil - payable by: ................................................................................................................................................................................ Name .................................................................................................................................................................................................... Street Address City/County State Zip Code THE PEOPLE OF THE STATE OF NEW YORK Witness Name: ..................................................................................... Social Security #:...................................................... Required by the State Comptroller* Witness Address: ..................................................................................................................................................................... TO Street Address City/County State Zip Code Date(s) of Appearance: ........................................................................ Date Summons Issued: ............................................ Summons Issued by: .............................................................................................................. G Copy of Summons Attached GREETINGS: Total Mileage: .................................. Total miles traveled to and from the Court. (by COMMAND WEordinary traveled route)YOU, that all business and excuses being laid aside, you and each of you attend before *By authority of Section 205 of the Social Security Act, 42 U.S.C. § 405 (c)(2)(C)(i). This at the information will be kept in a confidential envelope and not be available to the public. , the Honorable Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed For as a witness in this action on the part of the or adjourned date, to testify and give evidence Agency Use Only I hereby certify that the above witness appeared in this court on the date(s) of appearance mentioned above. According to the laws of the State of Maryland, CJ § 9-202, the per day compensation and itinerant allowances are as follows: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to ................... day(s) @................. $50 and $ damages sustained as the party on whose behalf this subpoena was issued for a maximum penalty ofper day =all.................................... a result of your failure to comply. ................... miles @................. per mile = $ .................................... Witness, Honorable Court in County, INV. DATE , one of Due $..................................... Total Amount the Justices of the day of REC. DATE EXEMPT , 20 PAY DATE AGENCY C00 GOODS AND SERVICES RECEIVED Quantity and Quality O.K.___________________________________________ NOT SUBJECT to Approval of the State Purchasing Bureau of Md. PCA Code Proj. 0004 Object Amount Vendor # (Attorney must sign above and type name below) Approved:................................................................................. Attorney(s) for 0413 Office and P.O. Address Prices and extension checked, payment not requested previously for items included in this invoice. By ____________________________________________________________________ JUDICIARY - ANNAPOLIS, MD. DCA 88 (Rev. 07/2003) Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com