COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. PROBATE COURT OF MONTGOMERY COUNTY, OHIO : Calendar No. ALICE O. McCOLLUM, JUDGE : Plaintiff(s) GUARDIANSHIP OF -against- JUDICIAL SUBPOENA : CASE NO. : AFFIDAVIT : (R.C. 3109.27) Defendant(s) : ...................................................... s.s. State of Ohio, County of (To be filed only when guardianship of the person of a minor is sought.) THE PEOPLE OF THE duly sworn,NEW YORK says: Affiant being first STATE OF deposes and TO 1. That the child's present address, the places where the child has lived within the last five years, and the names and present addresses of the person(s) with whom the child has lived during that period are: 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(not) participated as a, party, witness, or in any other capacity in at any recessed day of 20 , at o'clock in the noon, and any 2. That affiant has or adjourned date, to testify and give evidence as a in this or any other state. part of the witness in this action on the litigation concerning the custody of the child(ren) 3. That affiant has (no) information of any custody proceeding concerning the child(ren) pending in a court of this or any otherthis subpoena is punishable as a contempt of court and will make you liable to Your failure to comply with state. the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a 4. That affiant to comply. result of your failurehas (no) knowledge of any person not a party to the proceedings who has physical custody of the child(ren) or claims to have custody or visitation rights with respect to the child(ren). Witness, Honorable , one of the Justices of the Court in County, day , 20 If 2, 3, or 4 is answered in the of affirmative, and the space afforded is insufficient for full explanation, please attach and incorporate herein any necessary information. (Attorney must the Court of any custody he has a continuing duty to informsign above and type name below) Affiant realizes that proceedings concerning the child(ren) in this or any other state of which affiant obtains information during the pendency of this proceeding. Attorney(s) for Office and P.O. Address Sworn to before me and subscribed in my presence this day of . , Telephone No.: Facsimile No.: E-Mail Address: Notary Public Mobile Tel. No.: FORM 16.1 - AFFIDAVIT 09/01/91 American LegalNet, Inc. www.USCourtForms.com