COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)ERIEPROBATE COURT OF COUNTY, OHIOIN THE MATTER OF THE ADOPTION OF(Name after adoption)CASE NO.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PETITIONER'S ACCOUNT (R.C. 3107.10)R.C. 3107.10PRELIMINARY ESTIMATE ACCOUNTINGFINAL ACCOUNTING (To be filed not later than date petition filed)(To be filed not later than 10 days prior to date of final hearing)THE PEOPLE OF THE STATE OF NEW YORK TOThis accounting specified all disbursements of anything of value the petitioner, a person on the petitioner's behalf, and the agency or attorney made and has agreed to make in connection with the minor's permanent surrender under division (B) of Section 5103.15 of the Revised Code, placement under Section 5103.16 of the Revised Code, and adoption under Chapter 3107. (Attach extra sheets if necessary)5103.155103.16GREETINGS:DISBURSEMENTSACTUALDATENAME AND ADDRESSWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorablePHYSICIAN,located at County ofHOSPITAL/MEDICAL FACILITYo'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 roomATTORNEYYour 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.ACTUAL COST TO THE ATTORNEY AGENCY, one of the Justices of theACTUAL COST TO THE AGENCY MAINTENANCE AND MEDICAL CARE REQUIRED UNDER R.C. 5103.15Court in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)FOSTER CARE GUARDIAN AD LITEM COURT COSTS ALL OTHER DISBURSEMENTSAttorney(s) forTOTALOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:1/9718.9 PETITIONER'S ACCOUNTMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.CERTIFICATION OF PETITIONER'S ACCOUNTJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)The undersigned certifies this day of , that this accounting is true and accurate.Attorney or AgencyTyped or Printed Name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .AddressTHE PEOPLE OF THE STATE OF NEW YORK TOCityStateTelephone Number (include area code)GREETINGS:The petitioner has reviewed this accounting and attests to its accuracy this day of 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 ofPetitionero'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 roomPetitionerYour 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., one of the Justices of theCourt 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