COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : Index No. Calendar No. : JUDICIAL SUBPOENA Plaintiff(s) JUSTICE COURT, HENDERSON TOWNSHIP -against- : CLARK COUNTY, NEVADA : __________________________________, ) : ) Plaintiff Defendant(s) ) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . or .authorized . . . . .) . . . . . (Employer . . . . . . . . . . . agent of employer) ) ) vs. ) THE PEOPLE OF THE STATE OF NEW YORK __________________________________, ) Defendant. ) TO (NOTE: The request must be ) limited to one defendant ) only.) ) GREETINGS: ____________________________________) IN THE MATTER OF THE APPLICATION FOR A TEMPORARY ORDER FOR PROTECTION AGAINST HARASSMENT IN THE WORKPLACE Case No.____________________________ (To be completed by court staff) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before AFFIDAVIT , the Honorable at the Court located at County of The above named Plaintiff(s), being first duly sworn, deposes and says: 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 The Defendant named above has committed an act or acts constituting harassment in the workplace. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose OF POLICE DEPARTMENT ANDmaximum penalty of $50 and all damages sustained as a NAME behalf this subpoena was issued for a REPORT NUMBER WHERE A COMPLAINT result of your failure to comply. ABOUT THESE ACTS HAS BEEN FILED (IF APPLICABLE): ____________________________________________________________________________ Witness, Honorable , one of the Justices of the Court in The relevant information about my workplace is as follows: County, day of , 20 BUSINESS NAME: ADDRESS: ________________________________________________ (Attorney must sign above and type name below) ________________________________________________ ________________________________________________ ________________________________________________ Attorney(s) for The relevant information about the defendant is as follows: NAME: ADDRESS (if known): _______________________________________________ _______________________________________________ Office and P.O. Address _______________________________________________ _______________________________________________ Telephone No.: Facsimile No.: E-Mail Address: 1 Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. : Plaintiff(s) Calendar No. : JUDICIAL SUBPOENA The acts occurred as follows: (Be specific as to the alleged acts of the defendant, the identity -against: : of all relevant parties, all important dates and locations, etc. Also, please make sure that the information you provide is LEGIBLE.) : Defendant(s) : . . . . . . . . . ______________________________________________________________________________ ............................................. ______________________________________________________________________________ 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 *PLEASE ATTACH ADDITIONAL SHEET(S) IF MORE SPACE IS NEEDED. 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 Provisions Relating to Notice result of your failure to comply. (Please check the appropriate box.) Witness, Honorable , one of the Justices of the _____ The Defendant has been given advance notice about this Application for a Court in County, day of , 20 Temporary Order, based on the following: __________________________________________________________________ __________________________________________________________________ (Attorney must sign above and type name below) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Attorney(s) for _____ The Defendant has not been given advance notice about this Application for a Temporary Order. If this box is checked, you must fill out and submit an additional form from the court. This form is entitled Supplemental Affidavit Relating to Lack of Notice to the Defendant. Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: 2 Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. : Plaintiff(s) Calendar No. : JUDICIAL SUBPOENA I, therefore, request that a Temporary Order for Protection against Harassment in the Workplace -against: be issued against the Defendant so that the Defendant will be enjoined from contacting my : business and/or its employees and/or any person present at the workplace, and so that the Defendant will be ordered to stay away from my workplace. I also request that the Court : prohibit the Defendant from violating this Order via e-mail, correspondence, telephone, or agent. Defendant(s) : ...................................................... Under the penalty of perjury, I (Applicant) swear or affirm that the above information is true and that the requested Temporary Order for Protection Against Harassment in the Workplace should be granted. THE PEOPLE OF THE STATE OF NEW YORK Plaintiff’s Signature __________________________________________ TO PLEASE COMPLETE SECTION 1 OR 2 BELOW: GREETINGS: (1) NOTARY: PLEASE STAMP you attend WE COMMAND YOU, that all business and excuses being laid aside, you and each ofBELOW: before , the Honorable Court Signed and Sworn to or Affirmed at the located at County of in room Before ,Me the on This 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 _______ day of ______________, 20_____. Notary Public______________________________ 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 (2) UNSWORN DECLARATION (Per NRS 53.045): result of your failure to comply. (a) If executed in this state: Witness, Honorable , one of the Justices of the "I declare underday of of perjury20 the foregoing is true and correct." penalty that Court in County, , Executed on ___________________ (Date) (b) If executed outside this state: ___________________________________ (Attorney must sign above and type name below) (Signature) Attorney(s) for "I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct." Executed on ___________________ Office and P.O. Address ___________________________________ (Date) (Signature) Telephone No.: Facsimile No.: E-Mail Address: 3 Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com