COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Plaintiff(s) -against- Calendar No. : JUDICIAL SUBPOENA : : : SHELBY COUNTY DIVORCE / DISSOLUTION FORM DR-1 Defendant(s) : ...................................................... CASE NO._______________________ PART I -SOCIAL HISTORY THE PEOPLE OF THE STATE OF NEW YORK HUSBAND TO WIFE Name:______________________________ Name:_______________________________ Mailing Address:_____________________ Mailing Address:_________________________ GREETINGS: ___________________________________ _______________________________________ Residence Address: (if different than mailing all business and excuses being laid aside, you and each of you attend before Residence Address: (if different than mailing WE COMMAND YOU, that address)____________________________ address)______________________________ , the Honorable at the Court located County of ___________________________________ at ____________________________________ , on the day of , 20 , at o'clock in the noon, and at any recessed Socialin room Number:_______________ Security Social Security Number:_________________ or adjourned date, to testify and give evidence as a witness in this action on the part of the Birthdate:______________ Age:________ Birthdate: ________________ Age:________ Time of Residence in: Time of Residence in: Ohio________Your failure to comply with this subpoena is punishable as a contempt of Shelby County_____________ Shelby County__________ Ohio________ 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 Birthplace: City__________ State_______ Birthplace: City__________ State__________ result of your failure to comply. EDUCATION Witness, Honorable Court in Indicate Year Completed: County, , one of the Justices of the day of , 20 Elementary_____ High School _________ College _______ Grad School _________ Indicate Year Completed: Elementary ______ High School __________ College _________ Grad School __________ (Attorney must sign above and type name below) Unusual Mental or Physical Condition: __________________________________ Unusual Mental or Physical Condition: _____________________________________ Attorney(s) for MARRIAGE Date of Marriage:____________________ ___________________________________ Cohabiting at present: Yes______ No_____ Pending Pregnancy: Yes______ No______ Place of Marriage: (City and State):________ Office and P.O. Address _____________________________________ Date of Separation:_____________________ Due Date:_____________________________ Telephone No.: Facsimile No.: The number of this Marriage: Husband ___ 1 ___ 2 ___ 3 ___ 4 E-Mail Address: ___ 2 ___ 3 ___ 4 Wife ___ 1 Have there been actions previously filed to terminate this marriage? Mobile Tel. No.: Yes_____ No_____ American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. PART II - CHILDREN : Calendar No. CHILDREN RELATED TO THIS CASE : Plaintiff(s) NAME SEX -against- DOB AGE JUDICIAL SUBPOENA GRADE : SOC. SEC. # LIVING WITH : : Defendant(s) : ...................................................... HUSBAND’S CHILDREN (not of present marriage) NAME IS YORK THE PEOPLE OF THE STATE DOBNEW HUSBAND CUSTODIAN OF DOES HUSBAND PAY SUPPORT YES_______ NO_______ YES________ NO_______ YES_______ NO_______ YES________ NO_______ YES_______ NO_______ YES________ NO_______ YES_______ TO NO_______ YES________ NO_______ GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before YES_______ NO_______ YES________ NO_______ , the Honorable at the Court located at County of WIFE’S CHILDREN (not of present marriage) 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 NAME DOB IS WIFE CUSTODIAN DOES WIFE PAY SUPPORT YES_______ YES________ NO_______ NO_______ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to YES________ NO_______ the party on whose behalf this subpoenaYES_______ for aNO_______ penalty of $50 and all damages sustained as a was issued maximum result of your failure to comply. YES_______ NO_______ YES________ NO_______ Witness, Honorable Court in County, YES_______ NO_______ day YES_______ of , 20 NO_______ YES________ , one of the Justices NO_______ of the YES________ NO_______ PART III - INCOME (Attorney must sign above and type name below) EMPLOYMENT INFORMATION HUSBAND WIFEAttorney(s) for Name and Address of Employer: ______________________________________________ Name and Address of Employer: ____________________________________________ ______________________________________________ ____________________________________________ Office and P.O. Address ______________________________________________ Posit ion held:___________________________________ Telephone No.: Facsimile No.: E-Mail Address: Position held:___________________________________ Mobile Tel. No.: ________________________________________________ American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. Scheduled Paychecks Per Year: __12 __ 24 __ 26 __ 28 Scheduled Paychecks Per Year: __ 12__ 24 __ 26 __28 : Index No. Monthly Gross Income: $__________________________ Monthly Gross Income: $_____________________________ Annual Gross Income (attach copy of tax return and W-2 for previous year): __________________________________ Calendar No. Annual Gross Income (attach copy of tax return and W-2 for previous year): _____________________________________ : : Plaintiff(s) JUDICIAL SUBPOENA Gross Bonuses/Overtime - Anticipated / Received -againstfor this year: $___________________________________ Gross Bonuses/Overtime - Anticipated / Received : for this year: $_____________________________________ Gross Bonuses/Overtime - Received last year: $________ Gross Bonuses/Overtime Year - year before last: $______ Military - active duty: Yes_____ No_____ retired: Yes_____ No_____ : Gross Bonuses/Overtime - Received last year: $_____________ Gross Bonuses/Overtime Year - year before last: $__________ : Military - active duty: Yes_____ No______ retired: Yes_____ No______ Defendant(s) : ...................................................... SELF-EMPLOYED INCOME THE PEOPLE OF THE STATE OF NEW YORK Self-Employed Person: Husband ______ Wife ______ Joint ______ Name of Business: ___________________________________________________________________________________________ TO Type of Business: _________________________________________________________________________________________ GREETINGS: Business Address: _______________________________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court In Business Since: 19_____ 20_____located at of Employees______ No. Employer I.D. No.:_____________________ County of The business filed the following tax return(s): Individual (Schedule C) ______ Partnership __________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed ATTACH A COPY OF YOUR LAST YEAR’S BUSINESS FEDERAL INCOME TAX RETURN. YEAR: __________ or adjourned date, to testify and give evidence as a witness in this action on the part of the OTHER INCOME HUSBAND WIFE 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 Unemployment: $ ____________________________ Unemployment: $______________________________ result of your failure to comply. Worker’s Compensation: ______________________ Witness, Honorable SSI/SSD: $__________________________________ Court in County, day of Retirement/Pension; Annuities: $________________ Interest: $___________________________________ Worker’s Compensation: _______________________ , one of the Justices of the SSI/SSD: $_____________________________________ , 20 Retirement/Pension; Annuities: $_________________ Interest: $___________________________________ (Attorney must sign above and type name below) Dividends: $ ________________________________ Rentals: $___________________________________ Spousal Support Received: $____________________ A.D.C. / G.R.: $______________________________ Miscellaneous Income: $_______________________ Secondary Employment: $______________________ Employer Name: _____________________________ Employer Address: ___________________________ __________________________________________ Dividends: $ ________________________________ Rentals: $___________________________________ Spousal Support Received: $____________________ Attorney(s)G.R.: $______________________________ for A.D.C. / Miscellaneous Income: $_______________________ Secondary Employment: $______________________ Employer Name: _____________________________ Employer Address: ___________________________ Office and P.O. Address ____________________________________________ Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. PART IV - ALL ASSETS OF BOTH PARTIES : Index No. ( Indicate Owner, example: H = Husband, W = Wife, J = Jointly Owned) CHECKING / SAVINGS / CD’S / CASH: Owner : Acct. No. and Type Calendar No. Bank Plaintiff(s) -against- Amount : JUDICIAL SUBPOENA : : : Defendant(s) : REAL PROPERTY: (List. residence first .then other real . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . estate) Owner Location Estimated Value Amount Owed Name of Lender 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 MOTOR VEHICLES, BOATS on the in room , AND MOBILE HOMES: (Include untitled vehicles) 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 Owner Make/Model Estimated Value Amount Owed Name of Lender 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 STOCKS AND BONDS: (Include U.S. Savings Bonds) Owner Number of Shares (Attorney must sign above and type name below) Company Value Attorney(s) for Office and P.O. Address HOUSEHOLD GOODS: (attached itemized list if in dispute) LIFE INSURANCE: ( including life insurance through employer) Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Owner Policy Number Company Index No. Value Face Cash Value : Plaintiff(s) -against- Calendar No. : JUDICIAL SUBPOENA : : : RETIREMENT FUNDS, PENSION BENEFITS, IRAs, 401(k) Defendant(s) : . ............ ... . ... . Owner . . .Vested (Yes/No) . . . . . . . .Type .of .Plan . . . . . . . . . . . . . . . . . . . .Company Estimated Value 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 CLOSELY HELD BUSINESS / SOLE PROPRIETOR / CORPORATION / PARTNERSHIP: (CIRCLE ONE) Owner Name of Business Percentage Owned Estimated Value 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 INCOME TAX REFUNDS DUE PARTIES (FEDERAL AND STATE): FEDERAL: $_____________________ , 20 STATE: $________________________ (Attorney must sign above and type name below) OTHER ASSETS: (extraordinary tools, hobby equipment, antiques, riding mowers, jewelry, guns, cemetery lots, farm equipment, loans due parties, etc. Attorney(s) for Description: (attach separate sheet if necessary) ITEM VALUE ITEM VALUE Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. PART V - LIABILITIES : Index No. (Indicate party signing indebtedness, example: H = Husband, W = Wife, J = Jointly) : REAL ESTATE MORTGAGES: Debtor Plaintiff(s) Security Creditor -against- : Calendar No. JUDICIAL SUBPOENA Due Balance Monthly Payment : : : Defendant(s) : ...................................................... CAR LOANS: THE PEOPLE OF THE STATE OF NEW YORK Debtor Bank Security Monthly Payment Balance Due 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 OTHER BANKS LOANS / HOUSEHOLD FINANCE LOANS, ETC.: Your failure to comply with this subpoenaSecurity is punishable as a contemptPayment and will make you liable to Bank Monthly of court Balance Due 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. Debtor Witness, Honorable Court in County, , one of the Justices of the day of , 20 CREDIT CARD ACCOUNTS: Debtor Creditor (Attorney must sign above and type name below) Monthly Payment Balance Due Attorney(s) for Office and P.O. Address OTHER CREDITORS: Debtor Creditor Telephone No.: Facsimile No.: E-Mail Monthly Payment Address: Nature of Indebtedness Mobile Tel. No.: Balance Due American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. : : Plaintiff(s) -against- Calendar No. JUDICIAL SUBPOENA : PART VI - MONTHLY EXPENSES : : (To be completed ONLY in actions where child support is to be established AND a deviation from the Court guidelines is sought, or in actions where temporary or permanent spousal support is requested). : This form shows: _____ Expenses of myself and spouse Defendant(s)experience based on past ...................................................... _____ Expenses of myself only based on past experience _____ My estimated future expenses LIVING EXPENSES THE PEOPLE OF THE STATE OF NEW YORK Rent,TO Mortgage (include taxes) $ Heat (average) $ Food, Cosmetics & Toiletries $ Electric (average) $ Clothing (self) $ Water/Sewer $ Clothing (children) $ Cable T.V. $ GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Childthe Honorable Care $ $ , at theTelephone Court located at County of School Tuition $ Trash pickup $ in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, & Activities evidence as a witness in this action on the part of the School Supplies, Lunchesto testify and give $ Home Maintenance $ Auto Gas, Repair & Transportation $ Medical Insurance $ Prescription Medications Property Insurance $ 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 $ Auto Insurance $ result of your failure to comply. Unreimbursed Medical, Dental Hair Care $ Witness, Honorable Court in County, Laundry, Dry Cleaning Entertainment, Incidentals Life Insurance (self) $ $ Life Insurance (children) $ Other $ , one of the Justices of the day of , 20 $ A. TOTAL MONTHLY(Attorney must sign above and$________________ LIVING EXPENSES: type name below) DEBTS Attorney(s) for Creditor H/W/J Security Balance Monthly Payment Car Payment Office and P.O. Address Car Payment Charge Acct. Charge Acct. Charge Acct. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. Student Loan : Other : Index No. Calendar No. B. TOTAL MONTHLY DEBTS : -against- $_____________________ JUDICIAL SUBPOENA Plaintiff(s) : TOTAL MONTHLY EXPENSES : $____________________ : PART VII - ACKNOWLEDGMENT Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . of my . . . . This information.is complete and accurate.to .the best . . . . . belief.. . . . . . . . . . . . THE PEOPLE OF THE STATE OF NEW YORK ________________________________________________ Husband ________________________________________ Wife TO Sworn to and subscribed before me in my presence this __________ day of _________________________________, 20________. _____________________________________________ Notary Public 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.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com