COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.COURT OF COMMON PLEAS, JUVENILE COURT DIVISIONCalendar No.CUYAHOGA COUNTY, OHIOJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)PARTY INFORMATION SHEETCOMPLAINANT INFORMATION:NAME OF HOSPITAL: ADDRESS OF HOSPITAL: NAME OF CONTACT PERSON: PHONE NUMBER: NAME OF PHYSICIAN: NAME OF LEGAL COUNSEL FOR HOSPITAL: ADDRESS OF COUNSEL: PHONE NUMBER OF COUNSEL: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOFAMILY INFORMATION:CHILD:NAME: D.O.B.: ADDRESS: SOC. SEC. NO.: RACE: FATHER:NAME:ADDRESS: PHONE: D.O.B.: SOC. SEC. NO.: RACE: LEGAL GUARDIAN (GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in room)YES ( )NOMOTHER: NAME:ADDRESS: PHONE: D.O.B.: SOC. SEC. NO.: RACE: LEGAL GUARDIAN (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.)YES ( )NO, one of the Justices of theLEGAL GUARDIAN: NAME:ADDRESS: PHONE: D.O.B.: SOC. SEC. NO.: RACE: Court in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com