COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : Index No. Calendar No. : CIRCUIT COURT OF CLAY COUNTY, MISSOURI JUDICIAL SUBPOENA Plaintiff(s) PROBATE DIVISION -against- : No. : Matter of : , *minor / *disabled. Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .RECEIPT .OF. WARD/ PROTECTEE ......... .. ..... (475.315 RSMo.) I hereby acknowledge that THE PEOPLE OF THE STATE OF NEW YORK I have received the following property from my TO Conservator in full satisfaction of the balance due to me in accordance with the Final Settlement of my estate and the Order of this Court: GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at Signature: the Court located at County of Address: 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 ACKNOWLEDGMENT 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 of ________________________, 20___, before the On this____ day was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. undersigned, personally appeared , to me known to be the person described in and who signed the same as h____ free act Witness, Honorable and deed. Court in County, , one of the Justices of the day of , 20 IN TESTIMONY WHEREOF, I have hereunto signed my name and affixed my official seal. (Attorney must sign above and type name below) (seal) Attorney(s) for Notary Public Notary commission expires: *strike if inapplicable. Form 421 Revised 3/14/2003 By: Office and P.O. Address Clerk Deputy Clerk Telephone No.: Facsimile No.: E-Mail Address: Page 1 of 1 Tel. No.: Mobile American LegalNet, Inc. www.USCourtForms.com