COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.CENTRE COUNTY DRS CHANGE OF ADDRESS/NAME FORMJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Client for whom address/name change applies(please check one):Plaintiff(Social Security Number)Defendant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(Social Security Number)OLD ADDRESS:CHANGE OF NAME:THE PEOPLE OF THE STATE OF NEW YORK TONameCurrent NameGREETINGS:Street AddressNew NameWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,CityDate Name Change Effectivelocated at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomState and ZIPYour 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.NEW ADDRESS: NEW PHONE:Effective DateEffective Date, one of the Justices of theNameCourt in Witness, Honorableday of, 20 County,Street Address(Attorney must sign above and type name below)CityAttorney(s) forState and ZIPOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:SignatureDateMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com