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Petitioners-Respondents List Of Property And Debts (Dissolution Of Marriage) Form. This is a New Mexico form and can be use in 11th Judicial District Local District Court.
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Tags: Petitioners-Respondents List Of Property And Debts (Dissolution Of Marriage), New Mexico Local District Court, 11th Judicial District
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COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
ELEVENTH JUDICIAL DISTRICT COURT Plaintiff(s)
COUNTY OF McKINLEY
-againstSTATE OF NEW MEXICO
Calendar No.
:
JUDICIAL SUBPOENA
:
:
____________________________________,
Petitioner,
:
Defendant(s)
:
......................................................
vs.
Cause No. ____________________
____________________________________, YORK
THE PEOPLE OF THE STATE OF NEW
Respondent.
TO
(Circle one)
PETITIONER’S / RESPONDENT’S LIST OF PROPERTY AND DEBTS
[List all property and debts of both parties]
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at
Court
The parties have the following property and debts: the
located at
County of
in room
, on the
day of
, 20
o'clock in the
noon, and at any recessed
ASSETS , at
or adjourned date, to testify and give evidence as a witness in this action on the part of the
X
X
X
X
XX
X
X
X
X
X X X
circle letter
X X
XX
applicable for
X
X Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
X
X
XX
X
X
X
X
X X X
each item:
X X
XX
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and[B ] acquired sustained as a
all damages
X
X
X
X
X
X
X
X X X
before mar.
Whose
result X your failure to comply.
of
check
[G] by gift
Property
X
X
X
X
here
X
X
X
X
X X X
or inheritance
or
Witness, Honorable
, one of the Justices of the
if
[M] acquired
whose
Court Property
in
County,
day of Description , 20
none
Value
during mar.
name?
Home & Land owned or
being purchased
Other land/ or leased land
[B ] before
marriage
(Attorney must sign above and[G ] gift below)
type name
[M ] during
marriage
Attorney(s) for
Office and P.O.
[B ] before
marriage
[G ] gift
[M ] during
marriage
Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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......... ..
:
Index No.
:
Mobile Home
:
Plaintiff(s)
-against-
Calendar No.
[B ] before
JUDICIAL SUBPOENA
marriage
[G ] gift
[M ] during
marriage
:
:
X
X
X
X
X
X
X
X
X
X
X
X
......................
X
X
X
X
THE PEOPLE OF THE
Property
XX
XX
XX
. .X.
X .
X
X
X
X
:
X
X
X
Defendant(s) X
X
X
X
:
............................
X
X
X
X
check
here
STATE
if
none
X
X
X
X
X
X
X
X
X
X
X
X
X
OF NEW YORK
Description
Value
circle letter
applicable for
each item:
[B ] acquired
before mar.
[G] by gift
or inheritance
[M] acquired
during mar.
X
X
X
X
Whose
Property
or
whose
name?
TO
Cash on hand as of the date
of the divorce fling.
[B ] before
marriage
[G ] gift
[M ] during
marriage
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
[B ] before
Checking and of
located at
County Savings
marriage
accounts, Certificates of , on the
in room
day of
, 20
, at
o'clock in the
noon, and at any recessed
[G ] gift
Deposit adjourned date, to testify and give evidence as a witness in this action on the part of the
or (CD’s) with banks,
[M ] during
marriage
Credit Union accounts and
any other financial account
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose
all damages sustained as a
Retirement plans, stock behalf this subpoena was issued for a maximum penalty of $50 and[B ] before
marriage
result of your failure to comply.
options, bonuses, 401K plans,
[G ] gift
Erisa plans, Keogh plans,
[M ] during
Savings plans and all other
Witness, Honorable
, one of the Justices of the
marriage
pension andin
Court profit sharing and
County,
day of
, 20
other benefits
(Attorney must sign above and[B ] before below)
type name
Interest in any trust and all
property titled in someone
else which is being held for
either party or which either
party is using or paying for
Attorney(s) for
marriage
[G ] gift
[M ] during
marriage
Office and P.O. Address
2
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
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......... ..
:
Index No.
:
Household goods and
furnishings, including audio,
video, and computer
equipment
:
Plaintiff(s)
-against-
Calendar No.
[B ] before
JUDICIAL SUBPOENA
marriage
[G ] gift
[M ] during
marriage
:
:
:
Defendant(s)
:
......................................................
THE PEOPLE OF THE STATE OF NEW YORK
X
X
X
X
TO
X
X
X
X
X
X
X
XX
XX
XX
XX
X
check
GREETINGS:
X
X
X
X
here
if
WE
Property COMMAND YOU,
none
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
circle letter
X X
applicable for
each item:
X X
[B ] acquired
before mar.
Whose
[G] by gift
Property
or inheritance
or
[M] acquired
whose
andduring of you attend before
each mar.
name?
that all business and excuses being laid aside, you
Description
Value
,
the Honorable
at the
Court
[B ] before
Books, pictures and other art
located at
County of
marriage
objects, room
in antiques, stamp, ,coin,
on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
[G ] gift
tape, or adjourned date,other
compact disk and to testify and give evidence as a witness in this action on the part of the
[M ] during
collections or collectibles
marriage
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.
Wearing apparel
Witness, Honorable
Court in
County,
, one of
day of
, 20
[B ] before
marriage
the Justices of the
[G ] gift
[M ] during
marriage
(Attorney must sign above and type name below)
Furs and jewelry
Navajo rugs, arts & crafts
items
Attorney(s) for
[B ] before
marriage
[G ] gift
[M ] during
marriage
Office and P.O. Address
3
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
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......... ..
:
Index No.
:
Firearms and sports
photographic, and other
hobby equipment
Plaintiff(s)
-against-
Calendar No.
:
[B ] before
JUDICIAL SUBPOENA
marriage
[G ] gift
[M ] during
marriage
:
:
:
Interest in insurance policies:
Defendant(s)
:
.. .... .........
list each. policy. and itemize . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
surrender or refund value of
each
[B ] before
marriage
[G ] gift
[M ] during
marriage
THE PEOPLE OF THE STATE OF NEW YORK
TO
Annuities
[B ] before
marriage
[G ] gift
[M ] during
marriage
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at X
the X
Court X X
X
X
X
X
XX
X
X
X
circle letter
X X
located at
County of
XX
applicable for
in
, on the X X day of X
, 20
,
o'clock in the
noon,item: at any X X
recessed
X room
X
X
X
X
X
X at
X X X
each and
[B
or adjourned date, to testifyX X give evidence as a witness in this action on the part of the ] acquired
and
X
X
X
X
X
X
X
X
X
X X X
before mar.
Whose
check
[G] by gift
Property
X
X
X
here
X
X
X
X
X X X
or inheritance
or
Your failure to comply with this subpoena is punishable as a contempt of court[M] acquired
and will make you liable to
if
whose
Property
Value
name?
party on whose behalf none subpoena wasDescription a maximum penalty of $50 andduring mar. sustained as a
this
issued for
all damages
the
result of your failure to comply.
Stocks and interests in
incorporated and
Witness, Honorable
unincorporated businesses
Court in
County,
, one of
day of
, 20
Interests in partnerships or
joint ventures
[B ] before
marriage
the [G ] gift of the
Justices
[M ] during
marriage
[B ] before
(Attorney must sign above and type name below)
marriage
[G ] gift
[M ] during
marriage
Attorney(s) for
Government and corporate
bonds and other negotiable
and nonnegotiable
instruments
Office and P.O.
4
[B ] before
marriage
[G ] gift
[M ] during
Address
marriage
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
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COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
Accounts Receivable
Plaintiff(s)
-against-
Calendar No.
:
[B ] before
JUDICIAL SUBPOENA
:
:
marriage
[G ] gift
[M ] during
marriage
Alimony, maintenance
:
support and property
Defendant(s)
:
settlements to which you are
......................................................
or may be entitled.
[B ] before
marriage
[G ] gift
[M ] during
marriage
OtherTHE PEOPLE OF THE STATE OF NEW YORK
debts owing to you or
your spouse including tax
refunds.
TO
[B ] before
marriage
[G ] gift
[M ] during
marriage
[B ] before
Equitable or future interests,
marriage
GREETINGS: or
life estates, and right
[G ] gift
powers exercisable for the
[M ] during
WE other
benefit of party(ies) COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
marriage
,
the Honorable
at the
Court
than those listed.
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
X
X
X
X
XX
X
X
X
X
X X X
circle letter
X X
XX
applicable for
X
X Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
X
X
XX
X
X
X
X
X X X
each item:
X X
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and[B ] acquired sustained as a
all damages
XX
result X your failure to comply.
of
X
X
X
X
X
X
X
X X X
before mar.
Whose
check
[G] by gift
Property
X
X Witness,X
X
here
X
X
X
X
X ,X X the or inheritance
or
Honorable
one of
Justices of the
if
[M] acquired
whose
Court Property
in
County,
day of Description , 20
none
Value
during mar.
name?
Contingent and noncontingent
interests in the estate of a
decedent, death benefit plan,
life insurance policy or trust
[B ] before
marriage
(Attorney must sign above and type name below)
[G ] gift
[M ] during
marriage
Attorney(s) for
Office and P.O. Address
5
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
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......... ..
:
Index No.
:
All other claims of every
nature, including tax refunds,
counterclaims of the
party(ies), and right to set-off
claims, tort claims, contract
claims, injury claims.
:
Plaintiff(s)
-against-
Calendar No.
[B ] before
JUDICIAL SUBPOENA
marriage
[G ] gift
[M ] during
marriage
:
:
:
Defendant(s)
:
......................................................
License, franchises, and other
general intangibles.
[B ] before
marriage
[G ] gift
[M ] during
marriage
THE PEOPLE OF THE STATE OF NEW YORK
TO
Automobiles & trucks,
ATV’s, tractors, motorcycles
[B ] before
marriage
[G ] gift
[M ] during
and each of you
marriage
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, 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
[B ] before at any recessed
Boats, motors, and
or adjourned date, to testify and give evidence as a witness in this action on the part of the marriage
accessories
[G ] gift
[M ] during
marriage
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
Aircraft and accessories behalf this subpoena was issued for a maximum penalty of $50 and[B ] before
the party on whose
all damages sustained as a
result of your failure to comply.
Witness, Honorable
Court in
County,
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Property
XX
XX
XX
XX
, one of
day of
, 20
X
X
X
X
X
X
X
X
check
here
if
none
X
X
X
X
X
X
X
X
Description
Office equipment, furnishings
and supplies
X
X
marriage
[G ] gift
[M ] during
the Justices of the
marriage
X
circle letter
applicable for
X X X
each item:
(Attorney must sign above and type name below)
[B ] acquired
X X X
before mar.
[G] by gift
Attorney(s) for X
X X
or inheritance
[M] acquired
Value
during mar.
Office and P.O. Address
6
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
X
X
X
X
Whose
Property
or
whose
name?
[B ] before
marriage
[G ] gift
[M ] during
marriage
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......... ..
:
Index No.
:
Machinery, fixtures,
equipment, and supplies used
in business
:
Plaintiff(s)
-against-
Calendar No.
[B ] before
JUDICIAL SUBPOENA
marriage
[G ] gift
[M ] during
marriage
:
:
Inventory
[B ] before
marriage
[G ] gift
[M ] during
marriage
:
Defendant(s)
:
......................................................
Animals, Livestock
[B ] before
marriage
[G ] gift
[M ] during
marriage
THE PEOPLE OF THE STATE OF NEW YORK
TO
Crops-growing or harvested.
[B ] before
marriage
[G ] gift
and[M ] during
each of you
marriage
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you
attend before
,
the Honorable
at the
Court
located at
County of
[B ] before
Farming equipment and
in room supplies., on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
marriage
implements and
or adjourned date, to testify and give evidence as a witness in this action on the part of the ] gift
[G
[M ] during
marriage
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
[B ] before
Interest in any yourestate to comply.
result of real failure
contracts (either vendor or
vendee; specify)
Witness, Honorable
Court in
County,
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Property
X
XX
XX
XX
XX
, one of
day of
, 20
X
X
X
X
X
X
X
X
check
here
if
none
X
X
X
X
X
X
X
X
Description
7
marriage
[G ] gift
the [M ] during the
Justices of
marriage
X X X
circle letter
(Attorney must sign above and type name below)
applicable for
X X X
each item:
[B ] acquired
Attorney(s) for X
X X
before mar.
[G] by gift
X X X
or inheritance
[M] acquired
Value
during mar.
Office and P.O. Address
X
X
X
X
Whose
Property
or
whose
name?
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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......... ..
:
Index No.
:
Rights or claims under any
contract
Plaintiff(s)
-against-
Calendar No.
:
[B ] before
JUDICIAL SUBPOENA
marriage
[G ] gift
[M ] during
marriage
:
:
All other property of any kind
not already listed. Itemize.
[B ] before
marriage
[G ] gift
[M ] during
marriage
:
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
Have you sold, leased, give evidence as a witness in away anything in part of 24
or2.
adjourned date, to testify and conveyed, transferred, or given this action on the the past the months of a value
over $200? If so, describe:
Item
Consideration paid
Your failure to comply Namethis subpoena is punishable as a contempt of court and willValue you liable to
with &Address of
make when
Transferee
to you $50 and all damages sustained as a
Transferred
the party on whose behalf this subpoena was issued for a maximum penalty of
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
3.
Have you closed, substantially depleted, or cashed in any safe deposit accounts , CD’s,
Retirement or other benefit accounts, or insurance policies in the past 24 months? If so, describe:
Office and P.O. Address
Item
Institution
Amount
8
Disposition
Made
Date
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
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......... ..
:
Index No.
:
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
:
:
:
Defendant(s)
:
......................................................
4.
Have you given any one anything to hold for you? Is anyone holding or controlling any interest in
any money or property of any kind for you? If so, describe:
THE PEOPLE OF THE STATE OF NEW YORK
Item
Name and Address of Person Holding
Value
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
5.
Are you holding or controlling any interest in any money or property of any kind belonging
to anyone else? If so, describe: with this subpoena is punishable as a contempt of court and will make you liable to
Your failure to comply
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.
Item
Name and Address of Owner
Value
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
DEBTS
9
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
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......... ..
:
Index No.
:
X
X
X
X
X
X
X
X
Plaintiff(s) X
:
Calendar No.
X
X
circle letter
X
JUDICIAL SUBPOENAX
X
X
X
X
X
-againstX
X
X
X
:X
X
X
X
X
X
X
X
X
X
X
:X
X
:
Name & address of Creditor
....................................
Description
Defendant(s)
&
............
Purpose
Mortgage/Real Estate Contract
: Total
......
applicable for
each item:
[B ] acquired
before mar.
[G] by gift
or inheritance
[M] acquired
during mar.
X
X
X
X
X
X
X
Name debt is in.
Amount
[B ] before
marriage
[G ] gift
[M ] during
marriage
THE PEOPLE OF THE STATE OF NEW YORK
TO
Vehicles
[B ] before
marriage
[G ] gift
laid aside, you and each
[M ] during
Court
marriage
GREETINGS:
WE COMMAND YOU, that all business and excuses being
of you attend before
,
the Honorable
at the
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
Furnishings including TVs, audio equipment
& appliances
[B ] before
marriage
[G ] gift
Your failure to comply with this subpoena is punishable as a contempt ofduring and will make you liable to
court
[M ]
party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
marriage
the
result of your failure to comply.
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
Loans
[B ] before
marriage
[Gabove and type name below)
] gift
(Attorney must sign
[M ] during
marriage
Personal loans from family members
[B
Attorney(s) for ] before
marriage
[G ] gift
[M ] during
marriage
Office and P.O. Address
10
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
X
X
X
X
X
X
:
X
X
Plaintiff(s) X
Calendar No.
X
X
circle letter
X
JUDICIAL SUBPOENAX
X
X
X
X
X
-againstX
X
X
X
:X
X
X
X
X
X
X
X
X
X
X
:X
X
:
Name & address of Creditor
....................................
Description
Defendant(s)
&
............
Purpose
: Total
......
Taxes
THE PEOPLE OF THE STATE OF NEW YORK
TO
Utilities, including cell phones
applicable for
each item:
[B ] acquired
before mar.
[G] by gift
or inheritance
[M] acquired
during mar.
X
X
X
X
X
X
X
Name debt is in.
Amount
[B ] before
marriage
[G ] gift
[M ] during
marriage
[B ] before
marriage
[G ] gift
[M ] during
marriage
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court [B ] before
Insurance
located at
County of
marriage
in room
, on the
day of
, 20
, at
o'clock [G ]the
in gift
noon, and at any recessed
[M ] during
or adjourned date, to testify and give evidence as a witness in this action on the part of the
marriage
Judgments against either party.
[B ] before
marriage
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
[G ] gift
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
[M ] during
result of your failure to comply.
marriage
Credit Cards (identify each)
Witness, Honorable
________________________________
Court in
County,
________________________________
____
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
____________
Gas Credit Cards (identify each)
________________________________
________________________________
____
________________________________
________________________________
____
day of_______________
, 20
_______________
_______________
_______________
_______________
_______________
_______________
_______________
________
_______________
_______________
_______________
_______________
____
(write letter)
, one of the Justices of the
_______
__________ _______________
_______
__________ _______________
_______
__________ _______________
_______
__________ _______________
(Attorney must sign above and type name below)
_______
__________ _______________
_______
__________ _______________
_______
__________ _______________
Attorney(s) for
_______
__________ _______________
________
(write letter)
Office and P.O. Address
_______
__________
_______
__________
_______
__________
Telephone No.:
_______
__________
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
_______________
_______________
_______________
_______________
____
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
X
X
X
X
X
X
:
X
X
Plaintiff(s) X
Calendar No.
X
X
circle letter
X
JUDICIAL SUBPOENAX
X
X
X
X
X
-againstX
X
X
X
:X
X
X
X
X
X
X
X
X
X
X
:X
X
:
Name & address of Creditor
....................................
Description
Defendant(s)
&
............
Purpose
: Total
......
Merchant or service account (identify each)
________________________________
_______________
THE PEOPLE OF THE STATE OF NEW YORK
________________________________
_______________
____
_______________
TO
________________________________
_______________
________________________________
____
____
applicable for
each item:
[B ] acquired
before mar.
[G] by gift
or inheritance
[M] acquired
during mar.
X
X
X
X
X
X
X
Name debt is in.
Amount
_______
_______
_______
_______
(write letter)
__________
__________
__________
__________
_______________
_______________
_______________
_______________
____
GREETINGS:
Other debts (describe)
[B ] before
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
marriage
,
the Honorable
at the
Court [G ] gift
located at
County of
[M ] during
in room
, on the
day of
, 20
, at
o'clock in the
marriage noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
[B ] before
marriage
[G ] gift
[M ] court
Your failure to comply with this subpoena is punishable as a contempt ofduring and will make you liable to
marriage
party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
the
result of your failure to comply.
Use additional page if necessary.
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.:
12
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