COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar OHIO IN THE COURT OF COMMON PLEAS, ASHLAND COUNTY, No. DOMESTIC RELATIONS DIVISION : Plaintiff(s) -against- : : : Name JUDICIAL SUBPOENA : Plaintiff / First Petitioner vs. / and : : CASE NO. Defendant(s) : ...................................................... Name : Defendant / Second Petitioner : THE PEOPLE OF THE STATE OF NEW YORK TO WAIVER Of Rights Under R.C. 3119.961 et seq. The undersigned, name of signator, being one of the parties to this proceeding, acknowledges that this proceeding is a cause of action for the establishment of a parent and child relationship between the undersigned and the following minor children: GREETINGS: DATE OF you and WE COMMANDNAME OF CHILD business and excuses being laid aside, BIRTH each of you attend before YOU, that all , 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 The undersignedfailureacknowledgeswithpursuant to the Local punishable as a contempt of court and will make (Local DR to Your further to comply that this subpoena is Rules of Court of the Ashland County Common Pleas Court you liable Rule 15), the Court requires that a genetic test be conducted to assist in the determination of parentage in all such proceedings. 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. The undersigned specifically requests that he/she be excused from the Court=s requirement that genetic testing occur in this case, and VOLUNTARILY WAIVES all rights and causes of action which he/she may have under R.C. 3119.961 through R.C. 3119.967 to contest their status as Witness, Honorable , one of the Justices of the the legal parent of the above-named child(ren), as well as all rights to genetic testing pursuant to R.C. 3119.961 through R.C. 3119.967, now or in the future, for the purpose of determining his/her status as the biological and/or legal parent of any of the above-named children. Court in County, day of , 20 The undersigned further represents to the Court that he/she understands that by executing this Waiver, he/she shall be permanently bound by the Court=s determination and establishment of the undersigned as the biological and legal parent of the above-named child(ren), notwithstanding (Attorney must sign above and type name below) any provision of R.C. 3119.961 through R.C. 3119.967 to the contrary. The undersigned, through the execution of this Waiver, further represents that he/she understands that he/she has been provided with an opportunity to secure genetic testing to determine the paternity of the above-named children in this case, but that he/she voluntarily foregoes all current Attorney(s) for and future rights to secure genetic testing to challenge the establishment of a parent and child relationship between him/herself and the above-named children. __________________________________________ Office and P.O. Address Signature of Party Sworn to and subscribed in my presence this ______ day of _________________, 2003. Telephone No.: Facsimile No.: __________________________________________ E-Mail Address: Notary Public Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com