COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : IN THE UNITED STATES DISTRICT COURT JUDICIAL SUBPOENA Plaintiff(s) -against- THE DISTRICT OF NEW: MEXICO FOR : : -vs- No. _____________________________ Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK FINANCIAL AFFIDAVIT, APPLICATION TO PROCEED IN FORMA PAUPERIS AND ORDER (28 U.S. C. § 1915) TO I, ________________________________, make under oath the following statement GREETINGS: regarding my financial, residential, all business and excuses being laidand since I and each of to prepay before WE COMMAND YOU, that marital and employment status, aside, you am unable you attend , the Honorable at the Court fees and located at County of costs in the above-entitled case, make application to proceed as a pauper in accordance with in room , on the day of , 20 , at o'clock in the noon, and at any recessed or28 U.S.C. § 1915:testify and give evidence as a witness in this action on the part of the adjourned date, to Your failure to comply withRESIDENCEis punishable as a contempt of court and will make you liable to A. BACKGROUND AND this subpoena the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a 1. Full comply. result of your failure toName: ________________________________________________________ 2. Age: __________ Sex: __________ 4. How long at this address? __________ 5. Married? _______ Single? _______ Divorced? _______ Separated? ________ (Attorney must sign above and type name below) 6. Number of dependents: ______________________________________________ 7. Ages of children living with you: _______________________________________ Attorney(s) for 8. List relationship of other dependents living with you: Witness, Honorable , one of the Justices of the Present address: day of ____________________________________________________ Court in 3. County, , 20 Telephone No. _________________ __________________________________________________________________ Office and P.O. Address __________________________________________________________________ 9. List any dependents in items 7 and 8 depending on you for support: Telephone No.: __________________________________________________________________ Facsimile No.: E-Mail Address: Mobile Tel. No.: __________________________________________________________________ American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : B. EMPLOYMENT AND INCOME Plaintiff(s) Calendar No. : JUDICIAL SUBPOENA 1. Are you now employed? ___________ Are :you self-employed? _____________ -against- 2. Name and address of employer: ________________________________________ : __________________________________________________________________ 3. : Position: _______________________ Salary per month: $__________________ Defendant(s) : . . . . . . . . 4. . . . . .If .self-employed, .nature .of. business: . ____________________________________ .. . ............ ..... . ........ ....... 5. Income previous month from self-employment: $__________________________ 6. If unemployed, how long since last job or self-employment: _________________ 7. Any other income such as disability pay, worker’ compensation, social security, s pension, interests, note and loan repayments, dividends, trust funds, unemployment compensation? _____________________________________________________ 8. If so, indicate source and amount per month: $_____________________________ 9. Total monthly net income: $___________________________________________ 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 C. ASSETS in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date,Dotestify and any real estate? a witnessYes __________ No __________ to you own give evidence as in this action on the part of the 1. a. Description: __________________________________________________ b. Location: this subpoena is punishable as a contempt of court and will make you Your failure to comply with____________________________________________________ liable to the party on whose behalfEstimated Present Value: for a maximum penalty of $50 and all damages sustained as a this subpoena was issued _______________________________________ c. result of your failure to comply. d. Estimated outstanding mortgages or contracts on property: ____________ Witness, Honorable , one of the Justices of the ____________________________________________________________ Court in County, day of , 20 e. 2. Payments per month: __________________________________________ Do you own any automobiles? Yes __________ No ___________ (Attorney must sign above and type name below) a. b. Present value: _____________ Total amount owed: ________________ c. 3. Make: _______________ Model: _______________ Year: __________ Monthly Payments: ____________________________________________ Attorney(s) for Do you have any stocks or bonds? Yes __________ No ___________ a. b. 4. 5. Describe: ___________________________________________________ Present Value: ________________________________________________ Office and P.O. Address Do you have any cash in the bank? Yes __________ No ___________ Telephone No.: Facsimile No.: a. If so, indicate amount: __________________________________________ E-Mail Address: Do you have any cash in savings and loan associations? Yes ______ No _______ Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : 6. Index No. Calendar No. : Do you have any other assets not listed above, excluding household furnishings and JUDICIAL SUBPOENA Plaintiff(s) clothing? Yes __________ No ___________ -against- a. : If so, describe and give value: ___________________________________ : ____________________________________________________________ : Defendant(s) : . .D. . . . . DEBTS.AND. OTHER .OBLIGATIONS . . . . . . . . . .. ....... .... ........ ............... 1. Rent _______________ per month 2. Utilities _______________ per month 3. Creditors: THE PEOPLE OF THE STATE OF NEW YORK TO Total Due Monthly Payment _______________ GREETINGS: List: ______________ _______________ _______________ ______________ _______________ _______________ ______________ _______________ 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 _______________ _______________ noon, and at any recessed in room , on the day of ______________at , 20 , o'clock in the 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 4. Total Monthly $ result of your failure to comply. Payments: Witness, Honorable Court in County, , one of the Justices of the day of , 20 __________________________________________ Signature of Applicant/Affiant (Attorney must sign above and type name below) SUBSCRIBED AND SWORN to before me this ______ day of ________________, __________. Attorney(s) for __________________________________________ Notary Public Office and P.O. Address My Commission Expires: ______________________ Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : ORDER Plaintiff(s) G -against- Calendar No. : JUDICIAL SUBPOENA : The Court has considered the foregoing Affidavit and Application and the same is DENIED. : : G The Court has considered the foregoing Affidavit and Application and the same is Defendant(s) GRANTED. It is ordered that the commencement and prosecution of the : ...................................................... above-entitled suit, action, or proceeding is authorized without the prepayment of the filing fee, costs, or security therefor. However, any further proceedings involving costs must be specifically authorized in advance by the Court. THE PEOPLE OF THE STATE OF NEW YORK DONE at ____________ this ____ day of ______________, ____. TO __________________________________________ UNITED STATES MAGISTRATE JUDGE 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 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : IN THE UNITED STATES DISTRICT COURT JUDICIAL SUBPOENA Plaintiff(s) -against- THE DISTRICT OF NEW: MEXICO FOR : : Defendant(s) : ...................................................... Plaintiff(s), THE PEOPLE OF THE STATE OF NEW YORK -vs- No. _______________________ TO Defendant(s). GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before ORDER FOR SERVICE OF PROCESS , the Honorable at the Court located at County of U.S.C. § 1915(d), it appearing to in room This matter is before the Court sua sponte pursuant to 28o'clock in the , on the day of , 20 , at 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 Court that plaintiff is proceeding under 28 U.S.C. § 1915, and that personal service of the summons and complaint is required insubpoena is punishable as a contempt of court and will make you liable to Your failure to comply with this this matter, the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a IT IS THEREFORE result of your failure to comply. ORDERED that the U. S. Marshal is directed to serve the summons and complaint personally on defendant(s) as directed by the Clerk. Witness, Honorable Court in County, day of , one of the Justices of the , 20 __________________________________________ (Attorney must sign above and type name below) UNITED STATES MAGISTRATE JUDGE Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com