COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : PROBATE COURT OF HAMILTON COUNTY, OHIO : RALPH WINKLER,Calendar No. JUDGE Plaintiff(s) : : : : AFFIDAVIT OF INCOME AND EXPENSES Index No. GUARDIANSHIP OF CASE NO. JUDICIAL SUBPOENA -against- , MINOR Defendant(s) : . . . . STATE .OF. . . . . . . . COUNTY. OF .HAMILTON,. SS.. . . . . . . . . . . . OHIO, . . . . . . . . . . . . . . . . . . . . . . . . . . Now comes THE PEOPLE OF THE STATE TO (Name of YORK OF NEWAffiant) parent/guardian of (Name of Minor) who being duly sworn and cautioned, states as follows: 1. I am requesting the release of held in the name of from the funds on deposit at GREETINGS: 2. The purpose of the request for the release of funds is 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 3. or adjourned My marital status is evidence as a witness inand action on the part of the date, to testify and give this the number of members in my household is 4. 5. I am employed with I state that my spouse is employed with and my annual salary is $ and his/her annual Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on salarybehalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a whose is $ result of your failure to comply. 6. Court in My current monthly household expenses are as follows: Witness, HonorableMortgage/Rent County, day of , one of the Justices of the , 20 Utilities Food (Attorney must sign above and type name below) Clothing Medical Installment Loans Credit Cards Insurance Child Support Spousal Support TOTAL EXPENSES Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com Attorney(s) for Office and P.O. Address Page 1 of 2 H.C. FORM 116.70 - AFFIDAVIT OF INCOME AND EXPENSES 02/10/03 COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : CASE NO. Calendar No. Index No. 7. Household Income: AFFIANT-against- Plaintiff(s) : : : : JUDICIAL SUBPOENA OTHER ADULTS SPOUSE Net Wages Stock Dividends Interest Defendant(s) : .Security. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... Social Worker's Comp. VA Benefits THE PEOPLE OF THE STATE OF NEW YORK Annuity/Pension TO Child Support Spousal Support TOTAL GREETINGS: $ $ $ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before TOTAL - ALL INCOME FOR HOUSEHOLD $ 8. , the Honorable at the Court located at County of I am unable to pay for the proposed expenditure because 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 County, , one of the Justices of the day of , 20 Affiant Court in On this day of personally appeared before me Attorney(s) for (Attorney must sign above and type name below) , who being properly sworn and cautioned, did affix h name hereon. Notary Public Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Page 2 of 2 H.C. FORM 116.70 - AFFIDAVIT OF INCOME AND EXPENSES American LegalNet, Inc. www.USCourtForms.com