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Authorization To Disclose Financial Records Form. This is a Missouri form and can be use in 38th Circuit Local Circuit Courts.
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Tags: Authorization To Disclose Financial Records, 8, Missouri Local Circuit Courts, 38th Circuit
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
Plaintiff(s)
Calendar No.
:
JUDICIAL SUBPOENA
-against:
AUTHORIZATION TO DISCLOSE
FINANCIAL RECORDS
:
To:
____________________________________
____________________________________
Defendant(s)
____________________________________
:
:
......................................................
Re:
____________________________________
Social Security No.
THE PEOPLE OF THE STATE OF NEW YORK
You are hereby authorized and directed to furnish and release to ____________________
TO to any employee, agent or representative thereof any and all or any portion of the records,
and
documents and other writings and information in your possession or under your control
concerning all of my accounts with and deposits in your institution, whether open or closed, and
whether held solely in my name or jointly with another and further concerning all my loans and
GREETINGS:
lines of credit with your institution on which I am liable individually or jointly with another or as
a guarantor.
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 ofYou are further authorized to allow said persons to read, review, copy and have copied
inany and all records, notations, of
room
, on the
day memoranda, , and all at
20
, other recorded in the
o'clock information regardless of
noon, and at any recessed
whether itdate, to testify and give evidence as computerized disc. on the part ofalso authorized to
is written, recorded, or on a witness in this action You are the
or adjourned
communicate with said persons orally or in writing and to provide reports concerning the matters
addressed herein for the purpose of explaining or disclosing any other information requested
relative to such accounts and deposits.
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
All expense pertaining to the foregoing shall be paid by the party requesting the
result of your failure to comply.
information pursuant to this authorization and nothing herein shall be construed to make me
liable for those costs.
Witness, Honorable
Court in
County,
STATE OF MISSOURI
COUNTY OF
, one of the Justices of the
day of
)
) ss
)
, 20
__________________________________________
(Attorney must sign above and type name below)
Attorney(s) for
On this ____ day of ___________, _____, before me a Notary Public, personally
appeared the above named person who acknowledged signing the above and foregoing
instrument as a free act and deed.
Office and P.O. Address
__________________________________________
Notary Public
My Commission Expires:
38th Circuit Form 8 (Rev. 1-1-2000)
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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