COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. IN THE COMMON PLEAS COURT OF WARREN COUNTY, OHIO : JUVENILE DIVISION JUDICIAL SUBPOENA Plaintiff(s) -against- : Case No. Plaintiff/Petitioner(1) DOB ) : CSEA No. : Address Defendant(s) : JUDGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .). . . . . . . . MIKE POWELL V. ) THE PEOPLE OF THE STATE OF NEW YORK MAGISTRATE TO Defendant/Petitioner(2)/Respondent Affidavit of Expenses of DOB Address GREETINGS: Income and (Name) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court Date of Determination located at County of Of Parentage 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 Notes: This affidavit must be filed and served in accordance with Local Rules of Court. This affidavit must be filed and served with every motion that concerns a modification of support. You will be required to provide proof of income per local rule and O.R.C. 3113.215(B)(5). You are under a continuing legal duty to file an updated version of this form if you learn of any comply with this subpoena is punishable needed, attach additional will make you liable to Your failure to additional information. If more space is as a contempt of court and page(s). the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result [As failure to comply. I. Income of yourdefined in O.R.C. 3113.215(A)]: Witness, Honorable A. Gross Yearly Income from Employment , one of the Justices of the (If not known, please estimate. Put “EST” after each estimated figure.) Court in County, day of , 20 Father Gross Yearly Employment Income Mother (Attorney must sign above and type name below) Employer Payroll Address Attorney(s) for City, State, Zip Check the number of Paychecks per year Year-to-date Gross Income Prior Year’s Tax Refund WCJC Form 1 Eff. 6/1/02 o12 o24 o26 o52 o12 o24 o26 o52 Office and P.O. Address Through date of Through date of Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Disclosure Affidavit Page 1 Initialed _________ Financial American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : B. : Annual Overtime, Commissions, Bonuses Plaintiff(s) Calendar No. JUDICIAL SUBPOENA (If not known, please estimate. Put “EST” after each estimated figure.) -against- : : Mother Father : Year 3 is Overtime, Year 3 is Most Recent Commission, Most Recent Defendant(s) : . .Year. . . . . . . .Base . . . . . . . . . .Bonuses . . . . . . . . . . . . . . . . . . . .Year ... . . . . Income ....... 20 Year 1 20 Year 1 20 THE PEOPLE OF THE STATE OF NEW YORK Year 2 20 Year 2 20 20 Base Income Overtime, Commission, Bonuses Year 3 TO Year 3 Y-T-D This Year Through: Y-T-D This Year Through: GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , theSelf-Employment Income Honorable at the Court C. Gross located each estimated figure.) at County of (If not known, please estimate. Put “EST” after in room , on the day of , 20 , at o'clock in the noon, and at any recessed Use Gross Annual Figures for Most Recentgive evidence as a witness in this action on the part of the or adjourned date, to testify and Father Full Year. See O.R.C. 3113.215(A) Mother Business Receipts Ordinary & to comply Your failure Necessary with this subpoena is punishable as a contempt of court and will make you liable to Business Expenses 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. Net Business Income Witness, Honorable Court in County, D. Other Income , one of the Justices of the day of , 20 All other income, actual or expected, including pension, social security, workers compensation, commissions, royalties, disability benefits, trust income, annuities, reoccurring capital gains, unemployment benefits, rents, expense-sharing, dividends, interest, AFDC, SSI, food stamps, spousal support received from a prior (Attorney must sign above and type name below) spouse, etc. (If not known, please estimate. Put “EST” after each estimated figure.) Father Per Year Attorney(s) for Describe Mother Per Year Describe Office and P.O. Address WCJC Form 1 Eff. 6/1/02 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Disclosure Affidavit Page 2 Initialed _________ Financial American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Father Plaintiff(s) Calendar No. : E. Total Annual Income JUDICIAL SUBPOENA Mother Total gross annual income -against- : Total gross annual income Total average gross monthly income ¸ 12 = Total average gross monthly income : ¸ 12 = : Defendant(s) : Average . . . . . . . deductions . . . . . . .Less. . . . . . . . . . . . . . . . . . . . . . . . Average monthly deductions monthly . . . . . . . . . ... .... Less Total net monthly income = = Total net monthly income THE PEOPLE OF THE STATE OF NEW YORK F. Benefits of Employment TO (Use of company car, country club memberships, stock options, etc.) Father GREETINGS: Benefits Mother Values Benefits Values 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 II. Information Required for Support Calculation: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whoseChildren of these was issued for a maximum penalty of $50 and all damages sustained as a A. Minor or Dependent behalf this subpoena Parties (Include any child of the result of your failure to comply. parties who is over 18 and handicapped) Child’s Name Witness, Honorable Court in County, Date of Birth Residing with , one of the Justices of the day of , 20 (Attorney must sign above and type name below) B. Other Minor Children Living in My Household Child’s Name Date of Birth Attorney(s) for Relationship Office C. Other Minor Children of Mine, Not Living in My Household and P.O. Address Child’s name WCJC Form 1 Eff. 6/1/02 Date of Birth Residing with Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Disclosure Affidavit Page 3 Initialed _________ Financial American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Plaintiff(s) Father Calendar No. : III. Child Support Guideline Adjustment: JUDICIAL SUBPOENA Mother (All Figures Per Year): -againstCourt Ordered Child Support You Pay for Other Child(ren) in Another Case : Court Ordered Spousal Support You Pay to a Former Spouse (All Figures Per Year) : Number of Your Other Dependent Children Defendant(s) : . . . . . From . . . . . . . . . . . . . . . Living With .You . . . . . a .Previous Marriage. . . . . . . . . . . . . . . . . . . . . . . . . . . or Relationship Court Ordered Child Support You Receive for the Dependent Child(ren) You Indicated THE on Line AbovePEOPLE OF THE STATE OF NEW YORK Child Care Expenses You Pay for TO Child(ren) Subject of these Proceedings (Employment or Educational-Related) Local Income Taxes Paid or Rate of Tax where you Live or Work GREETINGS: or: % or: % WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Self-Employment Tax (5.6% of A.G.I.) the Honorable Health Insurance Premium for Children located at County of (Family Plan Cost Less Individual Plan Cost) in room , on the day of at the , Court , 20 , at o'clock in the noon, and at any recessed For Postor adjourned date, to testify and give evidence as a witness in this action on the part of the Parenting Determination Modifications Only: Current Spouse’s Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Gross the party on whose behalfIncome this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Number of Your Other Dependent Children result of your failure to comply. Living With You From Your Present Marriage or Relationship [Excluding Witness, Honorable unadopted step children] Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) OATH OF AFFIANT I, (print) hereby swear or affirm that the information set forth in this Affidavit of Income Attorney(s) for and Expenses above is true, complete, and accurate. I understand that falsification of this document may result in a contempt of court finding against me which could result in a jail sentence and fine, and that falsification of this document may also subject me to criminal penalties for perjury (O.R.C. 2921.22). Office and P.O. Address AFFIANT Sworn to and subscribed before me this WCJC Form 1 Eff. 6/1/02 Day of , . Telephone No.: Facsimile No.: Notary Public E-Mail Address: Mobile Tel. No.: Disclosure Affidavit Page 4 Initialed _________ Financial American LegalNet, Inc. www.USCourtForms.com