COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. : Calendar No. CIRCUIT COURT OF CLAY COUNTY, MISSOURI PROBATE :DIVISION JUDICIAL SUBPOENA Plaintiff(s) -against- : : Matter of No. , *minor - *disabled. : APPLICATION FOR SUPPORT AND MAINTENANCE Defendant(s) : . . . . . . .The .Conservator__ . . . . . . . . . . . . . . .to .the. Court .that the Protectee’s assets presently consist of . . . . . . . . . . . . . . . . herein states__ . . . . . . . . . . . . approximately $ , in Real Property and $ , Personal Property and, that the monthly income is anticipated to be as follows: THE PEOPLE OF THE Social Security YORK STATE OF NEW $ Supplemental Security Income GREETINGS: $ Veterans Administration TO $ Interest Income $ Other Income (state source) $ 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 or adjourned date, to testify and give evidence as a witness in this action on the part of the Total Per Month $ The regular monthly expenses are expected to be as follows: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Room and Board $ the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Medical Care $ Court in Witness, Honorable Drugs County, day of , 20 Other: $ , one of the Justices of the $ $ (Attorney must sign above and type name below) Total Per Month $ WHEREFORE, the Conservator___ requests___ that the Court allow the Conservator___ to expend up Attorney(s) the to $ , per month, of the Protectee’s funds forfor support and maintenance of the Protectee, and to account for the expenditures on each annual settlement. THE STATEMENTS AND REPRESENTATIONS IN THIS DOCUMENT ARE MADE UNDER OATH AND ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND Office and P.O. Address THEY ARE MADE SUBJECT TO THE PENALTIES OF MAKING A FALSE AFFIDAVIT OR DECLARATION. Date: Form 400 Revised 3/14/2003 Telephone No.: Facsimile No.: E-Mail Address: Page 1 of 1 Mobile Tel. No.: Conservator American LegalNet, Inc. www.USCourtForms.com