COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. PROBATE COURT OF LUCAS : COUNTY, OHIO Index No. JACK R. PUFFENBERGER, JUDGE : IN THE MATTER OF THE: Plaintiff(s) ‫ ٱ‬TESTAMENTARY -againstTRUST ‫ ٱ‬SPECIAL NEEDS TRUST Calendar No. : JUDICIAL SUBPOENA ‫ ٱ‬WRONGFUL DEATH TRUST : ‫ ٱ‬OTHER : OF _________________________________________________________, DECEASED, GRANTOR : CASE NO. _________________________ Defendant(s) : ...................................................... RECEIPTS AND DISBURSEMENTS [Attach to Trustee’s Account] THE PEOPLE OF THE STATE OF NEW YORK Page _____ of _____ pages TO Following is an itemized statement of receipts and disbursements by the fiduciary in the administration of his/her trust. GREETINGS: Item Voucher Value WE COMMAND YOU, that all business and excuses being laid aside, you and each of Value you attend before No. Amount Amount , 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 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 Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: PAGE 1 OF TRUSTEE’S ACCOUNT - FORM LCPC TST 25.5C (RECEIPTS AND DISBURSEMENTS) American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : CASE NO. _________________________ Page _____ of _____ pages : Item : Plaintiff(s) Voucher No. -against- : Index No. Calendar No. Value Value JUDICIAL SUBPOENA Amount $ Amount $ : : Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: 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 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 Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address ____________________________________ Telephone No.: Trustee Facsimile No.: E-Mail Address: PAGE 2 OF TRUSTEE’S ACCOUNT – FORM LCPC TST 25.5C (RECEIPTS AND DISBURSEMENTS) Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : CASE NO. _________________________ Index No. : BANK CERTIFICATE Calendar No. : N. B. Must be Plaintiff(s)when funds areJUDICIAL SUBPOENA executed on deposit. -against- : I HEREBY CERTIFY that the within named trustee, on the date stated below, had on deposit in : The _________________________________ of ________________________________, Ohio the sum : of $ ________________________ on _______________________________ to the credit of the trust of Nature of Deposit Defendant(s) : . ________________________________________. . . . . . . . . . ........................................... Bank THE PEOPLE OF THE STATE OF NEW YORK ________________________________________ TO By Dated Cashier GREETINGS: Trustee WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court BANK CERTIFICATE located at County of in room , on the , 20 , at o'clock in the N.day Must be executed when funds are on deposit. noon, and at any recessed B. of or adjourned date, to testify and give evidence as a witness in this action on the part of the I HEREBY CERTIFY that the within named trustee, on the date stated below, had on deposit in The _________________________________ of ________________________________, Ohio the sum 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 of $ of your failure to comply. result ________________________ on _______________________________ to the credit of the trust of Nature of Deposit ________________________________________ Witness, Honorable Court in County, day of , one of the Justices of the , 20 Bank ________________________________________ Dated By (Attorney must sign above and type name below) Cashier Attorney(s) for Trustee Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: PAGE 3 OF TRUSTEE’S ACCOUNT - FORM LCPC TST 25.5C (BANK CERTIFICATE) American LegalNet, Inc. www.USCourtForms.com