COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. Waiver of Confidentiality : Calendar No. Application for Judicial Vacancy and Personal Data Sheet Nebraska Judicial Nominating Commission : JUDICIAL SUBPOENA Plaintiff(s) I hereby state that to the best of my knowledge the answers to all questions contained in my application -againstand personal data sheet are true, and I understand that knowingly: providing false information may subject me to removal from office. : I understand that by submitting this application I am consenting to investigation and verification of any : information listed in both the Application for Judicial Vacancy and the Personal Data Sheet. Defendant(s) : . . . . I authorize. the. Nebraska. State .Bar. Association .or. any . . .its. committees, the office of the Counsel for . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . of . . . Discipline, the Judicial Qualifications Commission, educational institutions I have attended, any references furnished by me, employers, business and professional associates, law enforcement agencies, all governmental agencies and instrumentalities and all other public or private agencies or THEpersons maintainingSTATE OF NEW YORK citizenship, residency, age, credit, taxes, education, PEOPLE OF THE records pertaining to my employment, civil litigation, criminal litigation, law enforcement investigation, admission to the TO practice of law, service in the U. S. Armed Forces, or disciplinary history to release to the Judicial Nominating Commission or its agent(s) any information, files, records, or reports requested by the commission in connection wit h any consideration of me as a possible nominee for appointment to judicial office. GREETINGS: Submission of this application expresses my willingness to accept an appointment if tendered by the Governor, and my willingnessthatserve as judge in all matters falling under the jurisdiction of you Court before WE COMMAND YOU, to all business and excuses being laid aside, you and each of the attend for which I have submitted this application. If at the my name is submitted to the Governor for , the Honorable Court consideration, I authorize the located of the information contained in my Personal Data Sheet and the release at County of release of any ,other investigativeof State of Nebraska. noon, and at any recessed in room on the day materials to the Governor of the o'clock in the , 20 , at or adjourned date, to testify and give evidence as a witness in this action on the part of the Name (Please Print) 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, day of , 20 , one of the Justices of the Signature of Applicant (Attorney must sign above and type name below) Date Signed and sworn to this Attorney(s) for day of , . Office and P.O. Address Notary Public Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.:2: Application Package Appendix 12/98 – Pg. 5 of 5, APP American LegalNet, Inc. www.USCourtForms.com