COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : NORTH CAROLINA Index No. Calendar No. IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION : JUDICIAL SUBPOENA Plaintiff(s) * -CVD- * * COUNTY -against- : : *, ) : ) Plaintiff, ) Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) . . . . . . . . . . . . . . . . . . . . . . v. ) ) *, ) THE PEOPLE OF THE STATE OF NEW YORK ) Defendant. ) TO ______________________________) AFFIDAVIT _________________________________ (personnel officer), being first duly sworn, GREETINGS: deposes and says: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court That he/she is an employee of ____________________________________________ located at County of located in ____________________________________________________________; that in in the , on the , said , at o'clock record noon, hereto *,* room above entitled action,dayan employee of20 company; that the in the attached and at any recessed is of adjourned date, to testify and give evidence as a witness in this action on the part of the ofor*’s earnings, deductions, company benefits and length of employment is true and correct to the best of affiant’s information and belief. This thefailure to comply with this subpoena is punishable as a _______. of court and will make you liable to Your _______ day of __________________________, contempt 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, day of , one of the Justices _______________________________of the Affiant (personnel officer) , 20 _______________________________ Title: (Attorney must sign above and type name below) Subscribed and sworn to before me this the ______ 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.: Form “A” American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar No. : JUDICIAL SUBPOENA EARNINGS INFORMATION 1. Plaintiff(s) Earnings last calendar year, including bonus, if any: -against- a) b) gross: net: : $________________ $________________ : : Present rate of pay: $__________________ per _____________________. If paid on production or commission, what is present average gross pay? Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . ____________________.. . . . . . $_______________Per . . . . . . . . . . . . . . . . . . . . . . 2. 3. How often is employee paid? ____________________________________ THE PEOPLE OF THE STATE OF NEW YORK 4. TO Number of hours working per day: _______________________________ 5. Number of days working per week: _______________________________ 6. Deductions from gross pay per pay period: GREETINGS: a) State taxes: $ ______________________ b) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Federal taxes: $ ______________________ , the Honorable FICA: at the Court c) $ ______________________ located at $ ______________________ County of d) Medical Insurance *: in room How muchon the , of medical day of , 20 , at noon, * insurance premium is allocated foro'clock in the children? and at any recessed coverage of or adjourned date, to testify and giveper _________________________. the part of the $ ____________________ evidence as a witness in this action on 7. Number of exemptions claimed: _____________________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 8.the party onemployee lastthis subpoena was issued for a maximum penalty of $50 and all damages sustained as a Date whose behalf paid: _________________________________________ result of your failure to periods, if any, are employee’s earnings retained by employer? How many pay comply. ______________________________________________________________ Witness, Honorable , one of the Justices of the 9.Court Earnings this calendar year through date employee last paid, including bonus, if any: in County, day of , 20 a) b) gross: net: $ _____________________ $ _____________________ (Attorney must sign above and type name below) 10. Is employee paid a bonus? ________________________ If “yes” explain: a) How computed: _________________________________________ Attorney(s) for b) When paid: _____________________________________________ c) Amount paid last calendar year: ____________________________ d) Amount paid this calendar year: ____________________________ Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Form “B” American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : 11. : Index No. Calendar No. What pay increase, if any, has employee received in past twelve (12) months? : JUDICIAL Plaintiff(s) Increase amount(s): _________________________________________ SUBPOENA -against- : Date(s) received: __________________________________________ : 12. Nature of employment: ______________________________________ : 13. Date of hire: _______________________________________________ Defendant(s) : ...................................................... 14. Amount paid by employer on employee’s behalf for: a) b) c) d) e) Medical insurance Disability insurance: Dues: Retirement: Reimbursed Expenses: $ ______________per ______________. $ ______________per ______________. $ ______________per ______________. $ ______________per ______________. $ ______________per ______________. THE PEOPLE OF THE STATE OF NEW YORK TO 15. Amount GREETINGS: of overtime employee worked in the past twelve (12) months. ________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable of overtime that was available to employee in the Court at the 16. Amount past twelve (12) months. 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 17. Please describe changes employee should expect, if any, within three months in job description, compensation and/or working hours: 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 , one of the Justices __________________________________________________________________ of the 18. Court If not previously described herein, please describe changes, if any, employee has had in County, day of , 20 within past three months in job description, compensation and/or working hours: __________________________________________________________________ __________________________________________________________________ below) (Attorney must sign above and type name __________________________________________________________________ __________________________________________________________________ Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com