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Affidavit In Support Of Motion For Deferral-Waiver Of Fees Form. This is a Oregon form and can be use in Polk Local County.
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Tags: Affidavit In Support Of Motion For Deferral-Waiver Of Fees, Oregon Local County, Polk
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
:
AFFIDAVIT IN SUPPORT OF MOTION FOR DEFERRAL / WAIVER OF FEES
JUDICIAL SUBPOENA
Plaintiff(s)
-against:
Name________________________________________________ Age______ Marital Status_________
:
Address___________________________________________________Phone No._________________
:
DEPENDENTS OF APPLICANT
Defendant(s)
Name
Age
Relationship
Address
:
......................................................
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
FINANCIAL STATUS OF APPLICANT
A.TO OWNER OF REAL PROPERTY: Yes________ No________
Address______________________________________________________________________
In whose name_________________________________________________________________
AUTOMOBILE: Yes______No______ Year_______ Make____________Model__________
GREETINGS: Value $____________Amount Owed $_________ Owed to_____________________
Estimated
MOTORCYCLE: Yes______No______ and excuses being laid aside, you and each of you attend before
Year_______ Make____________Model__________
WE COMMAND YOU, that all business
Estimated
Owed
,
the Honorable Value $____________Amount at the $_________ Owed to_____________________
Court
STEREO EQUIPMENT: located at
Yes______No______Estimated Value $_______________________
County of
Amount Owed $____________ Owed to____________________________________________
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
JEWELRY: Yes______No______Estimated Value this action on the part of the
or adjourned date, to testify and give evidence as a witness in $_____________________
Amount Owed $____________ Owed to____________________________________________
FIREARMS: Yes_____No______Estimated Value $_____________________
Amount Owed $____________ Owed to____________________________________________
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
B.result Cash onfailure to comply.
of your Hand $____________ In Banks $______________ Stocks, Bonds, Etc $___________
C.
EMPLOYMENT INFORMATION
Witness, Honorable
, one of the Justices of the
EMPLOYED Yes______No_______ Period of Unemployment________________________
Court in
County,
day of
, 20
Last Job__________________________Present Employer______________________________
Address__________________________Time on Job__________________________________
Present Monthly Income $_________________Social Security No._______________________
(Attorney must sign above
Average Monthly Income (Past Year) $__________________________ and type name below)
Other Income Sources and Amount $_______________________________________________
D.
Attorney(s) for
OTHER ASSETS $_____________________________________________________________
E.
MONTHLY OBLIGATIONS:
To__________________________________For__________________Amount$_____________
Office and P.O. Address
To__________________________________For__________________Amount$_____________
To__________________________________For__________________Amount$_____________
To__________________________________For__________________Amount$_____________
To__________________________________For__________________Amount$_____________
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
F.
:
Plaintiff(s)
Calendar No.
JUDICIAL SUBPOENA
LIST UNPAID BILLS:
-against:
To__________________________________For__________________Amount$_____________
To__________________________________For__________________Amount$_____________
:
To__________________________________For__________________Amount$_____________
To__________________________________For__________________Amount$_____________
:
To__________________________________For__________________Amount$_____________
Defendant(s)
To__________________________________For__________________Amount$_____________
:
......................................................
OTHER PERSONS RESIDING IN THE APPLICANT’S HOME:
NAME
AGE
RELATIONSHIP
ADDRESS
____________________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
____________________________________________________________________________________
TO
____________________________________________________________________________________
INCOME OF LIVE-IN COMPANION, IF ANY $___________________________________________
LIST THE NAME, ADDRESS, TELEPHONE NUMBER AND RELATIONSHIP OF PERSONS WHO
GREETINGS:
CAN VERIFY THIS INFORMATION:
Address
Relationship
Phone No.
Name
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
STATE OF OREGON
)
or adjourned date, to testify and give evidence as a witness in this action on the part of the
) ss.
County of Polk
)
Your failure to comply first sworn, say that I am indigent contempt of court and fees listed on
I, the undersigned, being with this subpoena is punishable as a and unable to pay thewill 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
the attached motion for waiver of fees. I have no property, assets or other resources except those listed
result of your failure to comply.
herein. I have no property which I have in any way concealed or conveyed to anyone else, so help me
God. I make this affidavit under penalty for perjury.
Witness, Honorable
, one of the Justices of the
I, the undersigned do understand that I will be responsible for the filing fee in this matter,
Court in
County,
day of
, 20
even if this case is dismissed.
_______________________________________________
(Attorney must sign above and type name below)
Subscribed and Sworn to before me this _______day of _____________________, 20________.
Attorney(s) for
_______________________________________________
Clerk of Court/ Notary Public
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
