COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Approved, SCAO : STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY Index No. Original - Friend of the Court 1st copy - Plaintiff 2nd copy - Defendant Calendar No. CASE NO. : JUDICIAL Plaintiff(s) CERTIFICATE FOR INTERSTATE LIEN -against- SUBPOENA : Friend of the Court address FAX no. Telephone no. : Plaintiff name, address, and telephone no. : Defendant(s) : ...................................................... v THE PEOPLE OF THE STATE OF NEW YORK Defendant name, address, and telephone no. TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed 1. Payer has an arrearage that exceeds the amount of periodic support payments payable for one year under the payer's support or order. adjourned date, to testify and give evidence as a witness in this action on the part of the 2. The payer was provided notice that liens arise by operation of law and that payer's real and personal property may be encumbered or seized if the threshold arrearage is met. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to I certify the party on whose behalf are true. that the above statements 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 day of , one of the Justices of the , 20 Name (print or type) Title (print or type) (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: FOC 96 (12/00) CERTIFICATION FOR INTERSTATE LIEN American LegalNet, Inc. www.USCourtForms.com