COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : STATE OF NEBRASKA FORM NO. 16:4 3/91 rev. Index No. : Annual Accounting/Statement of Assets Calendar No. CASE NUMBER Beginning_______________ Ending_______________ Plaintiff(s) IN THE MATTER OF THE -againstGUARDIANSHIP/CONSERVATORSHIP OF : JUDICIAL SUBPOENA : : : ______________________________________ Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Ward). . . . . . . . . . . . . . ...... STATE OF NEBRASKA ) ) ss. COUNTY OF _____________________ ) THE PEOPLE OF THE STATE OF NEW YORK TO The undersigned Guardian/Conservator of person and property of the above named ward, being duly sworn, says this account is in all respects just and true, and that to the best of her/his knowledge and belief GREETINGS: she/he has accounted for all the property of the ward that has come into her/his possession or knowledge, or the possession forCOMMAND YOU, that all business and excuses being laid aside, you and each of you attend before WE anyone of her/him for said ward. , the Honorable at the Court located at County of DATE:______________________ of in room , on the day GUARDIAN/CONSERVATOR:___________________________ , 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 Address: Phone: ________________________________ ________________________________ 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 Subscribed and sworn to result of your failure to comply. before me on this ________ day of ________________, ______. Witness, Honorable Court in County, , one of the Justices of the day of , 20 ________________________________ (Notary Public) (Attorney must STATEMENT OF ASSETS sign above and type name below) Item Attorney(s) for Value $ Office and P.O. Address FORM NO. 16:4 Page 1 of 2 Telephone No.: Facsimile No.: TOTAL: E-Mail Address: Mobile Tel. No.: (Certificate of Proof of Possession is required to be attached to this form) American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. CASE NUMBER_______________________ : ______________________________________ Plaintiff(s) (Ward) -against- Calendar No. : JUDICIAL SUBPOENA : Beginning Balance : Date Check No. : Rec’d from/Paid to Purpose Defendant(s) : ...................................................... Amount paid or rec’d Balance THE PEOPLE OF THE STATE OF NEW YORK 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 or adjourned date, to testify and give evidence as a witness in this action on the part of the 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 result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address FORM NO. 16:4 Page 2 of 2 Telephone No.: Facsimile No.: (Attach additional sheets E-Mail Address: if necessary) Mobile Tel. No.: (Certificate of Proof of Possession is required to be attached to this form) Ending Balance American LegalNet, Inc. www.USCourtForms.com