COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Application For District 15B Indigent Index No. Lists : Calendar No. : JUDICIAL SUBPOENA NC Bar No. Name Plaintiff(s) Firm Name -against- : Office Address : *** Office must be physically located in District 15B *** Telephone Email Fax : Defendant(s) : ...................................................... Law School Attended: Date Graduated: Licensed to practice in North Carolina (month/year) Licensed to practice in other jurisdictions (month/year) THE PEOPLE OF THE STATE OF NEW YORK Please indicate below the list(s) you request to be placed on. Refer to Article IX for list description and requirements. TO [List 5 is currently not available]. List 1: Misdemeanors n/a List 5: Involuntary Commitment List 2: G through I felonies List 6: Child Support List 3: A through F felonies List 7: Parent Representation GREETINGS: List 4: Juvenile List 8: Special Proceedings Counsel WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Chatham Both , Court Requests for placement on the above list(s) are for: Orange the Honorable at the List briefly your of experience, included specialized CLE: trial located at County 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 list 2-3 attorney references: 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. Please indicate any additional information that will facilitate the decision regarding your placement on the list(s). You may Witness, Honorable , one of the Justices of the attach additional information that you desire to be considered. Court in County, day of , 20 (Attorney must sign above and type name below) At the discretion of the Indigent Defense Committee, attorneys are subject to an annual review to ensure quality representation and compliance with the 15B Judicial District Regulations for Appointment of Counsel in Indigent Cases. Attorney(s) for Office and P.O. Address DATE Updated: 6/20/2006 SIGNATURE PD-EA2 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Office of the Public Defender American LegalNet, Inc. www.FormsWorkflow.com