COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. : : Plaintiff(s) Calendar No. JUDICIAL SUBPOENA IN THE COURT OF COMMON PLEAS, ASHLAND COUNTY, OHIO -against: DOMESTIC RELATIONS DIVISION : _________________________________, : Case No. ________________ Plaintiff / Petitioner 1, Defendant(s) : . . .vs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. _________________________________, FINANCIAL AFFIDAVIT OF ______________________________ Defendant / Petitioner 2. THE PEOPLE OF THE STATE OF NEW YORK STATE OF OHIO, COUNTY OF ASHLAND, ss: TO Now comes the _____________________________ after being duly sworn and cautioned under law and states that the following is a true and accurate accounting of the financial assets, liabilities and expenses of the parties. The affiant also states as follows: GREETINGS: Information about Marriage: Date of this marriage: Place of Marriage: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before DatetheSeparation: of Honorable , at theWife is pregnant: Yes _______ Court No _______ located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed Minor and/or Dependent Children of evidence as a witness in this action on the part of the here, if none Check or adjourned date, to testify and give this Marriage (Names & DOB's):  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. Information about Parties: WIFE Witness, Honorable Court in County, HUSBAND , one of the Justices of the day of 20 Job ,Title Name of Employer Payroll Address (Attorney must sign above and type name below) Insurance available through employment Insurance company Attorney(s) for Address of Insurance Company Marginal Insurance Cost per pay for dependents COBRA conversion cost for spouse coverage Office and P.O. Address Paychecks per Year Year-to-Date Income Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: LOCAL TAX RATE American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : Index No. Calendar No. : JUDICIAL SUBPOENA Plaintiff(s) GROSS MONTHLY INCOME -against: WIFE TYPE OF INCOME HUSBAND : Employment Income : Unemployment Comp. Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Worker's . . . . . . . . . . . . . . . . Comp Disability Benefits Interest/Dividends THE PEOPLE OF THE STATE OF NEW YORK Pension/Social Security TO Public Assistance Child Support GREETINGS: $ Spousal Support Tax Refund WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court Other Income located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed $ GROSS a witness in this action or adjourned date, to testify and give evidence asMONTHLY INCOME on the part of the DEDUCTIONS FROM is punishable as a contempt of court and will make you liable to Your failure to comply with this subpoenaGROSS MONTHLY INCOME 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. WIFE TYPE OF DEDUCTIONS HUSBAND Witness, Honorable Court in County, Taxes , one of the Justices of the Social day of Security/Pension/Medicare , 20 401K Deduction Insurance Premiums (Attorney must sign above and type name below) Child Support Spousal Support Attorney(s) for Business Deductions $ $ TOTAL DEDUCTIONS $ Office and P.O. Address Telephone No.: NET MONTHLY INCOME $ Facsimile No.: E-Mail Address: Mobile Tel. No.: 2 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. : Calendar No. MONTHLY BUDGET INSTRUCTIONS: (1) Expenses should be listed in the weekly, annually, or monthly columns, as they are paid. IT IS NOT NECESSARY TO LIST EVERY EXPENSE IN ALL THREE COLUMNS. (2) : The total weekly expenses should be multiplied by 52 and divided by 12 to arrive at a monthly figure. This amount should be put on the total weekly expense line in the monthly column. The total annual JUDICIAL SUBPOENA Plaintiff(s) expenses should be divided by 12 and the result should be placed in the monthly column on that line. (4) The monthly column should be totaled, including the total weekly and annual expenses lines. -againstTYPE OF EXPENSE WEEKLY COST Rent or Mortgage : ANNUAL COST MONTHLY COST : Property Taxes : Property Insurance Gas/Fuel . . . . . . . . . . . . . . . . Oil/Propane Defendant(s) : ...................................... Electric Water/Sewer THE PEOPLE OF THE STATE OF NEW YORK Trash Disposal Basic Telephone Service TO Cable Television Home Maintenance GREETINGS: Automobile Loan Payment(s) Gasoline forWE COMMAND automobiles YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court Maintenance for automobiles located at County of Car Insurance 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 Groceries Personal Hygiene Clothing Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalffrom wages and not issued for a maximum penalty of $50 and all damages sustained as a Other Insurance not deducted this subpoena was listed forof your failure to comply. result home or car Uninsured health expenses Witness, Honorable Court in County, Educational expenses , one of the Justices of the day of , 20 Entertainment Child Care (Attorney must sign above and type name below) Credit card payments Loan payments not listed for home or car Attorney(s) for Other: Other: TOTAL WEEKLY EXPENSES [Column 1 x 52 ÷12 = Column 3] $ $ Office and P.O. Address TOTAL ANNUAL EXPENSES [Column 2 ÷ 12 = Column 3] $ Add annual, Telephone No.: monthly and weekly expenses Facsimile all computed on a as No.: monthly E-Mail Address: basis Mobile Tel. No.: TOTAL MONTHLY EXPENSES 3 $ $ American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : Index No. Calendar No. ASSETS OF THE PARTIES : JUDICIAL Plaintiff(s) (Attach additional sheets if necessary) -against- SUBPOENA : CASH AND BANK ACCTS. (List bank and acct. no.) ACCOUNT HOLDER(S) BALANCE : : Defendant(s) : ...................................................... WHOLE LIFE INSURANCE (List Company and Policy No) POLICY HOLDER(S) BALANCE THE PEOPLE OF THE STATE OF NEW YORK TO REAL ESTATE INTERESTS (List Location) GREETINGS: OWNER(S) (Joint, Husband or Wife) NET VALUE AFTER LIENS 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 INVESTMENTS to testify Identifying No.) OWNER(S) action on the part Wife) BALANCE or adjourned date, (Type and and give evidence as a witness in this (Joint, Husband, orof 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, PERSONAL PROPERTY (List location and description) day of , one of the Justices of the NET VALUE AFTER OWNER(S)(Joint, Husband, or Wife) , 20 LIENS (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: 4 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. : Calendar No. LIABILITIES OF THE PARTIES (Attach additional sheets if necessary) : JUDICIAL SUBPOENA Plaintiff(s) SECURED DEBTS -against(List Creditor and Account No.) DEBTOR(S) : (Joint, Husband, or Wife) MONTHLY PAYMENT BALANCE DUE : : Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO UNSECURED DEBTS (List Creditor and Account No.) DEBTOR(S) (Joint, Husband or Wife) MONTHLY PAYMENT BALANCE DUE 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 make disclosure of income and Affiant further states that she or he has been advised that this affidavit may be used to: (1) sign above and type name below) assets to the other party; (2) to assist in determining division of property; and to determine the amount and terms of support orders. Affiant states that the information contained in this affidavit is complete and accurate to the best of his or her information, knowledge and belief, under penalty of law. Attorney(s) for ______________________________________________ Plaintiff / Defendant / Petitioner 1 / Petitioner 2 Office and P.O. Address Sworn to and subscribed in my presence this _____ day of _________________, 20_____. Telephone No.: ______________________________________________ Facsimile No.: Notary Public E-Mail Address: Mobile Tel. No.: Financial Affidavit 2/2003 5 American LegalNet, Inc. www.USCourtForms.com