COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : IN THE COURT OF COMMON PLEAS, ASHLANDJUDICIAL SUBPOENA COUNTY, OHIO Plaintiff(s) DOMESTIC RELATIONS DIVISION -against: Plaintiff/Petitioner vs. : CASE NO. : Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .CHILD .CUSTODY AFFIDAVIT ....... ........... Defendant/Petitioner The , being first duly sworn according to law, states as follows concerning the custody of the minor child(ren) of the parties in the above-styled domestic relations action: THE PEOPLE OF THE STATE OF NEW YORK State the following information for each child of the parties: TO NAME DATE OF BIRTH Addresses of the child within past 5 years Dates at those addresses Who the child resided with 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 (1) Have you participated as a party, witness or in any other capacity, in any other litigation concerning the custody of any of the above child(ren) in this or any other state or do you have any information about such a custody action? YES NO Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to (2) Do you know of any person who has physical custody of any of the aforenamed child(ren), or who claims to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a have custody or visitation rights with respect to any of the child(ren), who is not a party to this case? result of your failure to comply. YES NO (3) Has any party toHonorable any of the Justices of the Witness, these proceedings been convicted of or pled guilty to , onecriminal offense involving an act that resulted in a child being determined toof an abused 20 neglected child or to a violation of O.R.C. 2919.25, be or Court in County, day , YES NO Domestic Violence? (4) Do you understand that you have a continuing duty to inform the court of any custody proceeding concerning YES (Attorney must sign above and type name below) NO the aforenamed child(ren) in this or any other state? If you answer AYES@ to questions 1, 2 or 3 above, you must attach another sheet to this affidavit Attorney(s) for explaining what information you have. ___________________________________________ Plaintiff/Defendant/Petitioner Office and P.O. Address Sworn to and subscribed in my presence, this ______ day of ___________________, 20_____. ___________________________________________ Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Notary Public American LegalNet, Inc. www.USCourtForms.com