COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : INTERVIEW of: qRESPONDENT : Index No. qCARETAKER Calendar No. : JUDICIAL SUBPOENA Plaintiff(s) Day/Date of Interview ________________, ___/___/___ -against- : Complete name__________________________________________________________________ Aliases________________________________________________________________________ : SSN _____-____-_____ D.O.B ___/___/___ Age ____ : Has Respondent been served? Defendant(s) qYes qNo : . . . . Has .Respondent. been .notified?. . .qYes q.No. . . . . . .... ........... ..... ....... ........ .. DISCUSS THE FOLLOWING WITH RESPONDENT THE qSubstance of petition PEOPLE OF THE STATE OF NEW YORK qNature of the proceedings TO qRespondent’s right to protest petition qIdentity of proposed fiduciary qRespondent’s rights as follows: q GREETINGS: Demand a jury trial on issue of disability qPresent evidence and confront and cross examine witnesses WEqAppeal the final decision on the petition excuses being laid aside, you and each of you attend before COMMAND YOU, that all business and the Honorable Attend any hearing at the Court q located at County of qHave an attorney ad litem appointed 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 MISCELLANEOUS BACKGROUND qWhere from qReligious activity qMarital background qStatus of driver’s license qEducation qOther activities qFamily Members 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 NATURE & EXTENT OF RESPONDENT’S PROPERTY result of your failure to comply. ASSETS qAutomobiles Witness, Honorable qReal Estate Court in County, qStocks & Bonds qJewelry day of LIABILITIES qMonthly Income qPension 20 Plan , qAccounts qChecking qCash On Hand , one of the Justices of the qIRA qInvestments qOther assets not covered (Attorney must sign above and type name below) qMonthly obligations qAccounts payable qNotes due others qNotes due banks qReal estate mtgs. qTaxes due qOther liabilities not covered Attorney(s) for HEALTH & MEDICAL CONDITION qAny physical disabilities qAlcohol consumption qAny mental treatments or consultations qDrugs Office and P.O. Address RELATIONSHIP WITH PROPOSED FIDUCIARY qWhat has Fiduciary been doing to assist Respondent before the petition? Telephone No.: qExplore Respondent’s attitude toward Fiduciary Facsimile No.: [Form 019, Rev. 2002.01.11] E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com ,