COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : APPLICATION FOR APPOINTMENT JUDICIAL SUBPOENA Plaintiff(s) -against- AS A : MEDIATOR IN THE TWELFTH COURT OF APPEALS : (Please type or print responses) : Date of Application: _______________________ Name:__________________________________ Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO Address: _____________________________ ______________________________ Office Phone: ________________________ Mobile Phone:________________________ Res. Phone: ________________________ GREETINGS: ______________________________ 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 E-Mail Add.: ________________________ recessed inFax No._________________________________ room , on the day of , 20 , at 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 1. Please describe any formal mediation training including continuing mediation training: _________________________________________________________________________________ to Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable 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 , one of the Justices of ________________________________________________________________________ the Court in County, day of , 20 2. Are you a full-time mediator?______________(yes/no) 2a. If yes, for how long?________________ (Attorney must sign above and type name below) 2b. If you are not a full-time mediator, what percentage of your practice is devoted to Attorney(s) for mediation? _______% 3. When did you first begin serving as a mediator? _____________________________________ 4. Approximately how many cases have you mediated? _________________________________ Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com Office and P.O. Address Page 1 of 2 COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : 5. What is your "batting average" or percentage of settled versus non-settled mediations?______ JUDICIAL SUBPOENA Plaintiff(s) _______________________________________________________________________________ 6. How many mediations have you handled while the case was on appeal? ______________ : : 6a. What is your "batting average" on these cases? ______________________________ Defendant(s) : . .7. . .In.what particular .substantive. areas.do you.specialize (i.e.,what are your former areas of practice, not . . ............ ........ .... ..... .............. -against- : necessarily board certification)? _________________________________________________ ______________________________________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK 8. Appellate mediators must frequently operate within short time frames due to impending appellate deadlines, e.g. due dates for the record, briefs, submission, etc. Normally, appellate mediation needs to be TO completed within 45 days after the court orders mediation. An appointed mediator is expected to act as the coordinator in promptly scheduling the mediation in order to meet the appellate court's deadlines. Do you perceive any problem which might hinder you from mediating cases within this limited time frame? GREETINGS: _____ Yes. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable No. at the Court _____ located at County of_____ Other. 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 If you answer other than "no," please explain._________________________________________ ______________________________________________________________________________ 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 Signature: ____________________________ Date: _________________________ (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Page 2 of 2 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com