COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : ____________ Court Index No. : ______________County ________________Tennessee Calendar Case Number CRIMINAL INJURIES No. : COMPENSATION JUDICIAL SUBPOENA Plaintiff(s) Page 1 of 1 -against- : State of Tennessee vs. : Defendant(s) _____________________________________________________________ : Defendant(s) To: Commissioner Department of Correction, State Office Building, Nashville, TN 37219 : ...................................................... This is to certify that the defendant in the above-captioned case has been assessed a privilege tax in the amount of $__________. OF THE STATE OF NEW YORK THE PEOPLE The Department of Correction is hereby placed on notice that the defendant: TO Has paid his privilege tax in full. GREETINGS: Has paid $ ___________________ towards his privilege tax. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Has not , the Honorable paid any amount of his privilege tax. at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed orIssued: ___________________ evidence as a witness ______________________________ adjourned date, to testify and give in this action on the part of the Clerk / Deputy Clerk - Circuit Court 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 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com