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Interim Monthly Income And Expense Statement Form. This is a New Mexico form and can be use in Domestic Relations Statewide.
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Tags: Interim Monthly Income And Expense Statement, 4A-122, New Mexico Statewide, Domestic Relations
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
DOMESTIC RELATIONS CIVIL FORMS
4A-122
Plaintiff(s)
:
:
Index No.
Supreme Court Approved
Calendar No.
October 29, 2001
JUDICIAL SUBPOENA
1
4A-122
-against:
2
3
[1-122]
:
4
5
S T A T E O F N E W M E X IC O
6
C O U N T Y O F __________________: ________
_
7
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ JU D IC IA L D IS T R IC T
:
8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Defendant(s) . . . . . . .
.
..........
9
10
_________________________________________,
11
P e titio n e r,
12
THE PEOPLE OF THE STATE OF NEW YORK
13
v.
N o. ______________
14
TO _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ,
15
16
R e s p o n d e n t.
17
18
INTERIM MONTHLY INCOME AND EXPENSES STATEMENT1
GREETINGS:
19
(fixed percentage for child expenses)
20
21
S TWET E O F N YOU, that all X I C O and) excuses being laid aside, you and each of you attend before
A COMMAND E W M E business
2 2 Honorable
) s sat the
.
,
the
Court
23
C of U N T Y O F _ _ _ _ _ _ at _ _ _ _ _ _
O
_
)
located
County
2 4 room
in
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
2 5 adjourned date, _ _testify and give_ _ _ _ _ _ _a _ _ _ (petitioner) (respondent) the t a t e u n d e r
I , to _ _ _ _ _ _ _ evidence as witness in this action on the part of s
or
26
p e n a lty o f p e rju r y th a t th e f o llo w in g is tr u e a n d c o rr e c t a t th is
27
t i m e : failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
Your
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
28
Husband
Wife
Combined
result of your failure to comply.
29
Column 1
Column 2
Column 3
30
, one of the Justices of the
31
1 . Witness, s m o n t h l y i n c o m e 2
G r o s Honorable
32
Court in
County,
day of
, 20
33
a . G ro s s m o n th ly w a g e s $ _ _ _ _ _ _ _ _ _
$_________
34
$_________
35
36
b.
R e n t a l (Attorney must sign above and _ _ name_ _ _ _ _
in c o m e
$ type _ _ below)
37
$_________
$_________
38
39
c . S e lf-e m p lo y m e n t in c o m e
$_________
40
$_________
$ _ _ _ _ _Attorney(s) for
____
41
42
d.
D iv id e n d s a n d in te re s t
43
$_________
$_________
$_________
44
Office and P.O. Address
45
e . O th e r in c o m e
$_________
$_________
46
$_________
47
Telephone No.:_ _ _ _ _
48
2 . T o ta l g ro s s m o n th ly in c o m e
$____
49
$_________
$ _ _ _ _ _Facsimile No.:
____
50
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
DOMESTIC RELATIONS CIVIL FORMS
4A-122
3
Plaintiff(s)
:
:
Index No.
Supreme Court Approved
Calendar No.
October 29, 2001
JUDICIAL SUBPOENA
1
3 . P a y ro ll d e d u ctio n s
-against:
2
3
a . F e d e ra l w ith h o ld in g
$_________
$_________
:
4
$_________
5
6
b.
S t a t e w i t:h h o l d i n g
$_________
7
$_________
$_________
:
8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Defendant(s) . . . . . . .
.
..........
9
c . E s t i m a te d ta x p a y m e n ts
$_________
10
$_________
$_________
11
12
d.
F IC A
$_________
$_____
THE PEOPLE OF THE STATE OF NEW YORK $ _ _ _ _ _ _ _ _ _
13
____
14
TO
15
e . M e d ic a re
$_________
$_________
16
$_________
17
18
f. H e a lth in s u r a n c e
$_________
$_________
GREETINGS: _ _ _ _ _ _ _ _
19
$_
20
21
g
L f e a n being laid i l i t i s u r a n c you attend before
WE. COMMAND YOU, that all business andiexcuses d d i s a baside,yyounand each ofe
2 2 Honorable_ _ _ _ _ _
$___
$__
$_________
,
the
at the _ _ _ _ _ _ _
Court
23
located at
County of
2 4 room h .
in
, on the
day of
, U n i o, n d u e s o'clock in the $ _ _ _ _ _ _at any recessed
20
at
noon, and _ _ _
2 5 adjourned _ _ _ to _ _ _ _and give evidence as a witness_in this action on the part of the
$ date, _ testify _
$__ ______
or
26
27
i . M a n d a t o r y r e ti r e m e n t $ _ _ _ _ _ _ _ _ _
$_________
28
$_________
29
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
3 0 party on. whosehbehalf_this_subpoena was issued$for _ _ _ _ _ _ _penalty of $50 and_ _ damages_sustained as a
j O t e r_ _ _ _ _ _ _ _ _ _ _
_ a maximum _
$ all _ _ _ _ _ _
the
31
$_________
result of your failure to comply.
32
33
4 . T o ta l p a y ro ll d e d u c tio n s $ _ _ _ _ _ _ _ _ _
$_________
Witness, _ _ _ _ _ _
, one of the Justices of the
34
$ _ _ _ Honorable
35
in #3)
Court in (Add itemsCounty,
day of
, 20
36
37
5 . N e t m o n th ly in c o m e
$_________
$_________
38
$_________
(Attorney must sign above and type name below)
39
(Subtract Line 4 from Line 2)
40
41
6 . M o n t h l y f i x e d e x p e n s e s 4:
42
a . R e s id e n c e 5
$_________
$_________
Attorney(s) for
43
$_________
44
b.
U tilitie s 6 $ _ _ _ _ _ _ _ _ _
$_____
45
____
$_________
46
c . C a r p a y m e n ts
$_________
$_________
47
$_________
Office and P.O. Address
48
d.
In s u ra n c e p re m iu m s $ _ _ _ _ _ _ _ _ _
49
$_________
$_________
50
(1 ) C a r o r o th e r v e h ic le
$_________
51
$_________
$ _ _ _ _ _Telephone No.:
____
2
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
DOMESTIC RELATIONS CIVIL FORMS
4A-122
7
Plaintiff(s)
:
:
Index No.
Supreme Court Approved
Calendar No.
October 29, 2001
JUDICIAL SUBPOENA
1
(2 ) L ife
$_________
$_________
-against:
2
$_________
3
(3 ) H e a lth 7
$_________
$_________
:
4
$_________
5
(4 ) H o m e o w n e rs 8 o r re n te rs
$_________
6
$_________
$ _ _ _ _ _ _ :_ _ _
7
(5 ) O th e r
$_________
$_________
:
8 . . . . . . . . $ ._ . . _ ._. _._ ._. _ ._ . . . . . . . . . . . .Defendant(s) . . . . . . .
_ . . . . .
.
. .
..........
9
e. D ay care9
$_________
$_________
10
$_________
11
f . C r e d i t c a r d p a y m e n t s 10 $ _ _ _ _ _ _ _ _ _
$_________
12
$_________
THE PEOPLE OF THE STATE OF NEW YORK L o a n p a y m e n t s
13
g.
$_________
14
$_________
$_________
TO
15
h.
C h i l d s u p p o r t p a y m e n t s 11
16
$_________
$_________
$_________
17
i. M e d ic a l
$_________
$_________
18
$_________
GREETINGS: O t h e r _ _ _ _ _ _ _ _ _ _ _
19
j.
$_________
$_________
20
$_________
21
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
2 2 Honorable t a l m o n t h l y f i x e d e x p eat the s
nse
$ Court _ _ _ _ _ _
___
,
the 7 . T o
23
$ _ _ _ _ _ _ _ _ _ located at
$_________
County of
2 4 room (Add items the#6 and #7)12
in
, on in
day of
, 20
, at
o'clock in the
noon, and at any recessed
2 5 adjourned date, to testify and give evidence as a witness in this action on the part of the
or
26
8 . N e t s p e n d a b l e in c o m e
$_________
$_________
27
$_________
28
(Line 5 minus Line 7)
29
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
3 0 party on whosefbehalf thisi subpoenaewas p e n dforbal maximum penalty of $50 and all damages sustained as a
9 . 1 / 2 o c o m b n e d n t s issued a e
the
31
i n c o m e (1/2 of Line 8 Column 3)13
$_________
result $ _your _ _ _ _to comply.
of _ _ failure _ _
32
33
, one of the Justices of_ _ _ _
34
1 0 .Witness, Honorable r a n s f e r r e d a n d r e c e i v e d 14
A m ount t
$ _ _ _ _ _ the
35
$ _ _ _ _ _County,
____
Court in
day of
, 20
36
37
11.
C h i l d s u p p o r t a d j u s t m e n t 15
$_________
38
$_________
(Attorney must sign above and type name below)
39
(see table, Use Note 15)
40
41
12.
T o t a l t o b e t r a n s f e r r e d 16
$_________
42
$_________
Attorney(s) for
43
44
45
_____________________________________
46
S i g n a tu r e
47
Office and P.O. Address
48
S u b s c ri b e d t o a n d s w o r n t o b e fo r e m e th i s _ _ _ _ _ _ d a y o f
49
_________________, _____, by _______________________.
50
Telephone No.:
51
3
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
DOMESTIC RELATIONS CIVIL FORMS
4A-122
Plaintiff(s)
:
:
Index No.
Supreme Court Approved
Calendar No.
October 29, 2001
JUDICIAL SUBPOENA
1
___________________________
:
2
N o t a r y P u b l i c-against3
4
USE NOTES :
5
:
6
1 . T h is fo rm is to b e u se d w ith a n In te rim O rd e r A llo c a tin g
7
I n c o m e a n d E x p e n s e s , D o m e s t i c R e la ti o n s F o r m 4 A - 1 2 3
Defendant(s) o
:
8 . . . . . . . . N. .M. . . .A . .. . U. n. l. e s .s.,. u. p .o. n . .m . o .t .i .o. n . . . f. .a. .p a r t y , t h e c o u r t o r d e r s
R .
.
. .
. . ..
. . . . .
.
9
t h e d i v i s io n o f s e p a r a te i n c o m e a n d e x p e n s e s , o n l y
10
c o m m u n it y i n c o m e a n d e x p e n s e s s h o u l d b e in c lu d e d o n
11
th is f o r m . In m in im a l o r n e g a t iv e i n c o m e c a s e s , th e c o u r t
12
w ill h a v e d i s c re tio n to f a s h i o n a n a p p r o p r ia te o r d e r .
THE PEOPLE OF THE STATE OF NEW YORK
13
14
2 . " G r o s s m o n th l y i n c o m e " is in c o m e f r o m a ll s o u r c e s
TO
15
e x c e p t c h il d s u p p o r t r e c e iv e d fr o m a p ri o r c o u r t o r d e r .
16
F o r s e l f - e m p l o y e d in d i v i d u a ls , g r o s s m o n t h l y i n c o m e
17
m e a n s g r o s s r e c e ip t s l e s s r e a s o n a b le a n d o r d i n a r y
18
b u s in e s s e x p e n s e s . F o r v a r y in g in c o m e a n d e x p e n s e s u s e
GREETINGS:e a v e r a g e o f t h e l a s t t h r e e ( 3 ) m o n t h s ' i n c o m e a n d
19
th
20
ex pen ses.
21
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
2 2 Honorabler o s s m o n t h l y i n c o m e i s ato b e c o m p uCourt b y u s i n g o n e o f
G
t the
te d
,
the
23
t h e f o l l o w i n g : locatedraty w a g e x a v e r a g e h o u r s w o r k e d p e r
hou l
County of
2 4 room w e e k, on the2 d i v i d of d b y 1 2 ,; 20 e e, k l y w ao'clock in the d i v noon,dand at any recessed
x 5
w
ge x 52
id e b y
in
day e
at
2 5 adjourned 2 ; eto testify and o w e e k s as aawitness in2 6 actionione d part of 1 2 ; t w i c e
1 date, v e r y t w give evidence w g e x this d i v d the b y the
or
26
m o n th ly x 2 . F o r v a ry in g w a g e s , u s e th e a v e ra g e o f th e
27
la s t th r e e m o n th s ' in c o m e .
28
29
3 . Your failurecto icomply with e p a y r o l lis punishable ias a contempt ofacourtsandswill make you liable to
" D e d u t o n s " a r this subpoena d e d u c t o n s f o r t x e , o c i a l
3 0 party on e c u r ibehalf h e asubpoena s u r issued for u n i o n d u e s , of $50 e m all damages sustained as a
s whose t y , this l t h i n was a n c e , a maximum penalty r e t i r and e n t a n d
the
31
o t h e r e m p l o y e r - r e la te d d e d u c tio n s . P a y r o l l d e d u c t i o n s
result of your failure to comply. p u t e d o n a m o n t h l y b a s i s a s d e s c r i b e d i n
32
a re to b e c o m
33
U s e N o te 2 .
Witness, Honorable
, one of the Justices of the
34
35
4 . " M o n t hCounty, e d e x pof n s e s " i n ,c20u d e p e r i o d i c e x p e n s e s e v e n
ly fix
e
l
Court in
day
36
th o u g h p a i d q u a r te r ly , s e m ia n n u a lly o r y e a r ly . F ix e d
37
e x p e n s e s a re to b e c o m p u te d o n a m o n th ly b a sis b y u s in g
38
o n e o f th e fo llo w in g : a n n u a l in c o m e o r e x p e n s e s d iv id e d
(Attorney a v sign g e o
39
b y 1 2 . F o r v a r y i n g e x p e n s e s , u s e t h e must e r aabove andftype name a s t
t h e l below)
40
th r e e m o n th s ' re c e ip t s o r e x p e n s e s .
41
42
5 . R e s id e n c e f ix e d e x p e n s e is m o r tg a g e o r re n t a c tu a l ly p a id .
43
I f a p a r t y r e c e i v e s f r e e r e n t , e.g., Attorney(s) n g w i t h p a r e n t s ,
b y l i v i for
44
t h a t p a r t y 's r e n t i s i m p u t e d a s z e r o . I f r e s i d e n c e e x p e n s e
45
is a m o rtg a g e p a y m e n t fo r th e r e sid e n c e o f a p a r ty , u n le s s
46
a l re a d y s e p a r a t e ly s ta t e d , in c l u d e i n s u r a n c e a n d ta x e s .
47
Office and P.O. Address
48
6 . I n c l u d e m o n t h l y a v e r a g e p a y m e n ts f o r g a s , e le c t r i c it y ,
49
w a ter, s e w e r , r e f u s e a n d b a s ic te le p h o n e b ill, if n o t p a id
50
a s p a rt o f re n t. U se a v e ra g e fo r last 1 2 m o n th s if k n o w n .
Telephone No.:
51
4
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
DOMESTIC RELATIONS CIVIL FORMS
4A-122
Plaintiff(s)
:
:
Index No.
Supreme Court Approved
Calendar No.
October 29, 2001
JUDICIAL SUBPOENA
1
7 . D o n o t i n c lu d e m e d i c a l, d e n t a l, l i a b i l i t y , l i f e o r o t h e r
-against:
2
in s u ra n c e th a t is d e d u c te d b y p a y ro ll d e d u c tio n .
3
4
8 . D o n o t i n c l u d e h o m e o w n e r s i n s u r: a n c e p r e m i u m s i f t h e
5
p r e m i u m is in c l u d e d a s p a r t o f th e r e s id e n c e e x p e n s e ,
:
6
L in e 6 (a ).
7
8 . . . . 9 .. . . D. .a.y . c .a. r. e . f i x .e. d . .e.x .p. e .n. sDefendant(s) . . -. r e .l .a t e d d a y c a r e a n d d o e s
e is w o r k . . :
.
.
.
. .
. ... .
. . ...........
9
n o t i n c l u d e b a b y - s i t t i n g o r o c c a s io n a l d a y c a r e .
10
11
10.
" C re d it c a r d p a y m e n t s " is lis te d a s a f ix e d e x p e n s e
12
a n d in c lu d e s o n ly th e m in im u m m o n th ly p a y m e n t a s
THE PEOPLE o f THE STATE OF NEW YORKg o f t h e p e t i t i o n .
OF t h e d a t e o f t h e f i l i n
13
14
TO 1 1 .
15
A n y r e g u la r m o n t h l y p a y m e n t o r d e re d b y a p r i o r
16
o r d e r o f c h il d s u p p o r t o r a l i m o n y , w h i c h i s a c tu a l l y
17
p a id , is a fix e d e x p e n s e .
18
GREETINGS: L i n e 8 . " N e t s p e n d a b l e i n c o m e " a n d " c o m b i n e d n e t
19
12.
20
s p e n d ab le in c o m e " a re d e te rm in e d b y s u b tra c tin g
21
L i n e 7 , t o t a that o business and excuses p e n laid " , f r o m L each 5 you attend before
WE COMMAND"YOU, l m all n t h l y f i x e d e x being s e s aside, you and i n e of ,
2 2 Honorable " n e t m o n t h l y i n c o m e " . at the
,
the
Court
23
located at
County of
2 4 room N e g a, ton the c o m b of e d n e t, 20s p e ,n d a b l e o'clock in m e . noon, and at any recessed
iv e
i n c o the
If th e
in
day i n
at
2 5 adjournedc o m to testify andegive p e n d a b la witness in this actionn e the,parto l u m n 3 ) i s
" date, b i n e d n t s evidence as e i n c o m e " ( L i on 8 C of the
or
26
a n e g a ti v e n u m b e r , a n d t h e re a r e n o c h i l d r e n , a d ju s t t h e
27
a ll o c a t i o n s o f i n c o m e o r e x p e n s e s b e tw e e n t h e p a rt i e s , o r
28
t r a n s f e r a n a m o u n t f r o m o n e p a r t y t o a n o th e r s o t h a t t h e
29
a m o u n to comply s p e n d a b l e is c o m e o a t h e " H u s b a n d " a n d
Your failure t o f n e twith this subpoena i npunishablefas r contempt of court and will make you liable to
3 0 party on w i f e " o n this n e 9 i s was issued for a maximum penalty of $50 iand all1 0 , 1 1 sustained as a
" whose behalf L i subpoena e q u a l . D o n o t c o m p l e t e L n e s damages
the
31
a n d 1 2 . If L in e 8 , C o lu m n 3 h a s a n e g a tiv e o r m in im a l
result of your failure toncomply. t s p e n d a b l e i n c o m e " , a n d t h e r e a r e c h i l d r e n ,
32
"com bi ed ne
33
th e c o u r t w ill n e e d to f a s h i o n a n a p p r o p r ia te f o rm to
Witness, Honorablei m i n c o m e a n d e x p e n s e s o f t h, e p ofrthee s .
one a t i Justices of the
34
d iv id e i n t e r
35
Court in
County,
day of
, 20
36
13.
L in e 9 .
E q u a liz in g s p e n d a b le in c o m e .
If " n e t
37
s p e n d ab le in c o m e " o n L in e 8 , C o lu m n 3 , is a
38
p o s itiv e n u m b e r , d iv id e " c o m b in e d n e t s p e n d a b le
(Attorney i n e c h c o l u m n
39
i n c o m e " b y t w o a n d e n t e r t h e r e s u l tmust signaabove and type name below)
40
o f L in e 9 .
41
42
14.
L i n e 1 0 . A m o u n t t r a n s f e rr e d a n d r e c e iv e d . T h e
Attorney(s) i
43
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a m o u n t o f th e t r a n s f e r o r re c e ip t , s u b t r a c t L in e 9
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a b l e i n No.:
5
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
DOMESTIC RELATIONS CIVIL FORMS
4A-122
Plaintiff(s)
:
:
Index No.
Supreme Court Approved
Calendar No.
October 29, 2001
JUDICIAL SUBPOENA
1
F o r e x a m p l e , i f t h e h u s b a n d h a s a n e t s p e n d a b l e in c o m e
-against2
o f $ 1 , 0 0 0 . 0 0 p e r m o n t h a n d t h e w i:f e h a s a n e t s p e n d a b l e
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:
4
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5
i n c o m e , e n te r t h e re s u l t, $ 7 5 0 .0 0 , o n L i n e 9 , u n d e r
6
C o lu m n 1 .
T o d e t e r m i n e t h e :a m o u n t t h e h u s b a n d
7
tr a n s f e r s, su b trac t L in e 9 o f C o lu m n 1 fro m L in e 8 o f
:
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9
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10
h u s b a n d to th e w ife .
11
12
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L in e 1 1 . C h ild re n . If L in e 8 , C o lu m n 3 , is a p o s itiv e
THE PEOPLE n u m b e r , a n OFdNEW tYORK t f o r c h i l d s u p p o r t i s m a d e b y
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13
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15
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18
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D o not
GREETINGS: c o u n t c h i l d r e n w h o a r e c o v e r e d b y a p r i o r c h i l d
19
20
supp ort order.
21
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
2 2 Honorable O n e c h i l d
1 Court
0%
,
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at the
23
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26
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27
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28
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31
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32
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33
h u s b a n d a n d w if e (C o lu m n 3 , L in e 8 , is $ 1 ,5 0 0 .0 0 ) a n d
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, e 8 , the Justices . 0 0
34
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35
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36
L in e 1 1 in th e h u s b a n d a n d w if e c o lu m n s .
37
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39
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h u s b a n d h a s p r i m a r y c u s t o d Telephone No.: s b a n d w i l l
y , th e h u
6
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
DOMESTIC RELATIONS CIVIL FORMS
4A-122
1
2
3
4
5
Plaintiff(s)
tr a n s f e r $ 1 0 0 .0 0 to t h e w if e .
-against-
:
:
Index No.
Supreme Court Approved
Calendar No.
October 29, 2001
JUDICIAL SUBPOENA
:
[A p p ro v e d , e ffe c tiv e N o v e m b e r 1 , 2 0 0 0 u n til N o v e m b e r 1 ,
2 0 0 1 ; a p p ro v e d , e ff e c tiv e N o v e m b e r : , 2 0 0 1 .]
1
:
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
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
7
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com