COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Plaintiff(s) -against- Calendar No. : JUDICIAL SUBPOENA : : : Defendant(s) : ...................................................... IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT THE PEOPLE OF THE STATE OF NEW YORK ) ___________________________________, Plaintiff/Petitioner, ) ) v. ) ) ___________________________________, ) GREETINGS: Defendant/Respondent.) TO AFFIDAVIT FOR DEFERRAL OF COSTS/FEES Case No. ________________________ 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 the ‘Plaintiff/Petitioner ‘Defendant/Respondent, that I County of I swear/affirm that I am in room , on the day of , 20 , at o'clock in the noon, and at any recessed am unable to pay necessary fees, that I support ______ people, and that my assets, monthly or adjourned date, to testify and give evidence as a witness in this action on the part of the income, and expenses are as follows: 1. Name, age and relationship of people I am supporting: 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. 2. Date of Birth: _______________________________ 3. Employer Names: ___________________________________________________ Employer Address: __________________________________________________ (Attorney must sign above and type name below) __________________________________________________ Length of Employment: _______________________ Monthly Pay (Net): ___________________________ Witness, Honorable , one of the Justices of the Oregon Driver’s License Number: _______________ Court in County, day of , 20 Attorney(s) for 4. All other income (including spouse’s income): Monthly Total: ______________________ Sources: __________________________________________________________ Office and P.O. Address Telephone No.: Facsimile AFFIDAVIT FOR DEFERRAL OF COSTS/FEES - Page 1 of 2 No.: FC(9/10/03) E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : 5. Index No. Calendar No. : All other assets: What it is worth What you owe JUDICIAL SUBPOENA Plaintiff(s) Real Property: _________ ________ -against: Motor Vehicles: _________ ________ Other Property (guns, jewelry, stocks, bonds, etc.): : ____________________________________________________________ ____________________________________________________________ : 6. Bank Accounts and Cash:Defendant(s) ____________________________________________ : ...................................................... 7. Money owed to me or my spouse by others: ______________________________ __________________________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK 8. Expenses, Monthly: Housing $ _________ owed to ______________________________ TO Car Pmts $ _________ owed to ______________________________ Loan Pmts $ _________ owed to ______________________________ $ _________ owed to ______________________________ $ _________ owed to ______________________________ GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Other Living Expenses: , the Honorable at the Court $ _________ for __________________________________ located at _________ for __________________________________ County of $ in room , on the day of $ _________ for at , 20 , __________________________________recessed o'clock in the noon, and at any or adjourned date, to testify and give evidence as a witness in__________________________________ this action on the part of the $ _________ for DATED this _____ day of _________________________, _______. 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. Signature Witness, Honorable Court in County, day of ____________________________________ , one Printed/Typed Name of the Justices of the , 20 ____________________________________ Address ____________________________________ (Attorney must City/State/Zip sign above and type name below) ____________________________________ Telephone Number Attorney(s) for Subscribed and sworn to before me this _____ day of ____________________, _____. ____________________________________ Office and P.O. Address Deputy Clerk of Court/Notary Public My Commission Expires: ______________ Telephone No.: Facsimile AFFIDAVIT FOR DEFERRAL OF COSTS/FEES - Page 2 of 2 No.: FC(9/10/03) E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com