COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : UNITED STATES DISTRICT COURT WESTERN DISTRICT OF NEW YORK Plaintiff(s) -against- Plaintiff, v Index No. Calendar No. : JUDICIAL SUBPOENA Revised 05/01 WDNY : ___________-CV-___________ : APPLICATION FOR APPOINTMENT OF COUNSEL : Defendant(s). Defendant(s) : ...................................................... My name is __________________________ ___________________________ and I am the plaintiff in the above THE PEOPLE OF THE STATE OF NEW YORK action. I hereby apply to the Court for appointment of counsel to represent me in this action. In support of this application, I ask the court to consider the following information: TO 1. My case concerns the following issue(s) (briefly summarize your case): GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before 2(a). I am unable to retain an attorney to represent me because I do not have the funds to do so. , the Honorable at the Court located at County of 2(b). [Fill this in if true] I have applied for leave to proceed in forma pauperis. My motion to proceed as in room , on the day of , 20 , at o'clock in the noon, and at any recessed a poor person was filed on or adjourned date, to testify and give evidence as a witness in this action on the part of the 2(c). [Fill this in if true] By Court Order filed on I was granted leave to proceed as a poor person pursuant to 28 U.S.C. § 1915. , Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 3(a). I have behalf this find my own issued but have been unable to of $50 and all the party on whose attempted tosubpoena wasattorney for a maximum penaltydo so because damages sustained as a result of your failure to comply. Witness, Honorable , one of the Justices of the 3(b). I have discussed my case with the following attorneys (include attorney’s name and telephone number, Court in County, day of , 20 and attach any correspondence which indicates that an attorney has declined to represent you): (Attorney must sign above and type name below) 4. I believe that the following circumstances demonstrate why the Court should grant my request for an Attorney(s) for appointed attorney: Office and P.O. Address WHEREFORE, plaintiff asks this Court to appoint an attorney to represent plaintiff in this action. I declare under penalty of perjury that the foregoing is true and Telephone No.:best of my knowledge, information correct, to the and belief. Facsimile No.: _____________________________ DATE E-Mail Address: Mobile Tel. No.: SIGNATURE American LegalNet, Inc. www.USCourtForms.com