COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : : Plaintiff(s) -against- Calendar No. JUDICIAL SUBPOENA : Cindy Carpenter : Clerk of Courts : Defendant(s) : ...................................................... Notice to Butler County Auditor THE PEOPLE OF THE STATE OF NEW YORK Application for Unclaimed Funds TO Unclaimed funds are hereby requested to be released. The records of the Butler County Clerk of Courts reflect that the applicant is entitle to receive these funds. GREETINGS: Please mail check directly to: 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 Applicant’s Name:_______________________________________________________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed Applicant’s Address______________________________________________________ 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. Amount of Unclaimed funds requested: $____________________________________ Witness, Honorable , one of the Justices of the Driver’s License #________________________________________________________ Court in County, day of , 20 Applicant’s Signature:_____________________________Date:__________________ (Attorney must sign above and type name below) Finance Department Use Only Date of pay-in:______________________________ Pay-in #:_____________________________ Attorney(s) for I certify the applicant is the true and authorized party and is entitled to receive the funds requested. ____________________________ Date ________________________________________________ Office and P.O. Address Authorized Finance Department Representative Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com