COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. IN THE COMMON PLEAS COURT OF WARREN COUNTY, OHIO : JUDICIAL SUBPOENA Plaintiff(s) JUVENILE DIVISION -against- : Case No. Plaintiff/Petitioner(1) DOB Address ) : CSEA No. : Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) . . . . . . JUDGE . MIKE POWELL V. THE PEOPLE OF THE STATE OF NEW YORK ) MAGISTRATE TO Defendant/Petitioner(2)/Respondent Information for Parenting Proceeding (O.R.C. 3109.27) DOB GREETINGS: Address 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 party in every parenting Notes: By law, this affidavitthe in room , on must be filed and served , with the at pleading filed by each noon, and at any recessed day of 20 , first o'clock in the (custody/visitation) testify and give evidence as a party has athis action duty while this the is pending to inform the proceeding in this court. Each witness in continuing on the part of case or adjourned date, to court of any parenting proceeding concerning the child(ren) in any other court in this or any other state. If more space is needed, attach an additional page. 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 Affiant _____________________________________________ states as follows: result of your failure to comply. ________________________________________________________________________________ Witness, Honorable Court in County, 1. , one of the Justices of the day of The name, birth date, Social Security Number (if any) of each child whose custody/visitation is at issue in this case is: , 20 (Attorney must sign above and type name below) Attorney(s) for __________________________________________________________________________________________ 2. The present home address of the child(ren) is: Office and P.O. Address __________________________________________________________________________________________ 3. The child(ren) currently reside(s) with WCJC Form 3 Eff. 6/1/02 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel.Financial Disclosure Affidavit Page 1 No.: Initialed _________ American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .. what .adult(s)? : Index No. ___________________________________________________________________________________________ : 4. All other places and dates where the child(ren) have lived during the last 5 years, and the names of all-against- with adult(s) whom they lived at each address, are as follows: Plaintiff(s) Calendar No. : JUDICIAL SUBPOENA : : : _____________________________________________________________________________________________ 5. Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . all The.name(s) .and. current.address. of . . . . . . . . . . . . . . . . . . . . . . . adults listed above are: __________________________________________________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK 6. Do you know of any litigation TO anywhere, past or present, which concerns the custody, visitation, or care of the child(ren)? GREETINGS: __________________________________________________________________________________________ 7. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable to #6 is “yes”, state any at the Court If the answer located at County of other information you have about any in room , on the day of , 20 , at o'clock in the noon, and at any recessed parenting proceeding concerning the or adjourned date, to testify and give evidence as a witness in this action on the part of the child(ren) now pending in a court of this or any other state. Include the case number, the name of the court and the Your court. address of the 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. __________________________________________________________________________________________ 8. State the Witness,and address of any name Honorable Court day personinwho is not County, to this of a party proceeding: (A) who has physical possession of the child(ren) or (B) who claims to be a parent of the child(ren) and is either the residential parent and legal custodian, or has visitation rights with the child, or (C) who is a person other than a parent of the child(ren) who has custody or visitation rights. , one of the Justices of the , 20 (Attorney must sign above and type name below) Attorney(s) for __________________________________________________________________________________________ Office and P.O. Address 9. Are you now, or have you ever been, a party to any civil or criminal case or any investigation concerning child abuse, child neglect, or domestic WCJC Form 3 Eff. 8/1/02 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel.Financial Disclosure Affidavit Page 2 No.: Initialed _________ American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . so, violence? . If . state each court, case : name, case number, date and nature and outcome of the case: : Index No. Calendar No. ___________________________________________________________________________________________ : JUDICIAL SUBPOENA Plaintiff(s) 10. Do you have any domestic violence -against: protection orders or any other : restraining orders issued against you, or on your behalf against any other : person? If so, state each court, case name, case number, date and nature and Defendant(s) : ....... . ... .... outcome. of. the .case: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . THE PEOPLE OF THE STATE OF NEW YORK OATH OF AFFIANT TO I hereby swear or affirm that the answers above are 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). GREETINGS: AFFIANT WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before the Honorable at Sworn to and subscribed before me this the day of 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 Notary Public 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 WCJC Form 3 Eff. 8/1/02 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel.Financial Disclosure Affidavit Page 3 No.: Initialed _________ American LegalNet, Inc. www.USCourtForms.com