COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. CHILD SUPPORT OBLIGATION WORKSHEET REQUIRED LOCATION INFORMATION : Calendar No. Court: ________________________________ Case No: ______________________ : JUDICIAL SUBPOENA Plaintiff(s) Petitioner: ____________________________ Respondent: ______________________ -against: As required by 62A-11-304.4, U.C.A., "Upon the entry of an order in a proceeding to establish paternity or to : establish, modify, or enforce a support order, each party shall file identifying information and shall update that information as changes occur: (i) with the court or administrative agency that conducted the proceeding, and (ii) : after October 1, 1998, with the state case registry." THE FOLLOWING INFORMATION MUST BE SUBMITTED AT THE TIME THE CHILD SUPPORT OBLIGATION Defendant(s) : . . .WORKSHEET.IS. SUBMITTED. Whether. you. are. the .Petitioner. or. the.Respondent, please fill out the information .......... . ................ .. .. .. ...... . .. for yourself and the other party to the best of your ability. If any information is unknown, please so indicate. Do not leave any space blank. THE PEOPLE OF THE STATE OFone) _____ custodial parent _____ non-custodial parent PETITIONER: I am the (check NEW YORK Social Security Number _______________________________ TO Driver License Number ___________________________ State __________________ Residential Address ______________________________________________________________ Mailing Address (if different than residential address:) ______________________________________________________________________________ GREETINGS: Telephone Number: _______________________ Date of Birth: _______________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable _____________________________________________________ at the Court Employer: located at County of Employer's Address: _______________________________________________________________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed Employer's Phone Number: _______________________________________ or adjourned date, to testify and give evidence as a witness in this action on the part of the THIS INFORMATION IS CURRENT AS OF ___________________ (date) RESPONDENT: Social Security Number __________________________________________________ will make you liable to Your failure to comply with this subpoena is punishable as a contempt of court and the party on whose Number ___________________________ State __________________ damages sustained as a Driver License behalf this subpoena was issued for a maximum penalty of $50 and all result of your failure to comply. Residential Address ________________________________________________________________ Mailing Address (if different than residential address:) Witness, Honorable , one of the Justices of the _________________________________________________________________________________ Court in County, day of , 20 Telephone Number: __________________________Date of Birth: _____________________ Employer: _____________________________________________________ Employer's Address: _____________________________________________________________ (Attorney must sign above and type name below) Employer's Phone Number: _____________________________________ THIS INFORMATION IS CURRENT AS OF ___________________ (date) Attorney(s) for Federal Law contains a prohibition against disclosing federal case registry information (name, social security number, date of birth, state) if the State has notified the registry there is reasonable evidence of domestic violence or child abuse or that disclosure of the information could be harmful to the parent or the child. If you wish to request the information be "safeguarded" (that is, not disclosed), check in the appropriate place below. Office and P.O. Address _____________________________________ (Petitioner or Attorney for Petitioner) I request that this information be safeguarded (not disclosed) ______ Telephone No.: Facsimile No.: _____________________________________ (Respondent or Attorney for Respondent) E-Mail Address: I request that this information be safeguarded (not disclosed) ______ Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar No. CHILD SUPPORT OBLIGATION WORKSHEET REQUIRED LOCATION INFORMATION : JUDICIAL SUBPOENA Plaintiff(s) AS REQUIRED BY TECHNICAL AMENDMENTS TO WELFARE REFORM SECTION 653(h)(2) (federal law) and U.C.A. -against62A-11-103(14), THE FOLLOWING INFORMATION MUST BE SUBMITTED : FOR EACH CHILD AT THE TIME THE CHILD SUPPORT OBLIGATION WORKSHEET IS SUBMITTED. : : Name: ___________________________________________________ Defendant(s) : . . . . . . Date. of. Birth: .________________________________ .... . ..... ................................... Social Security Number: _____________________________________ THE PEOPLE OF THE STATE OF NEW YORK Name: ___________________________________________________ TO Date of Birth: ________________________________ Social Security Number: _____________________________________ GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and Name: ___________________________________________________ each of you attend before , the Honorable at the Court located at CountyDate of Birth: ________________________________ of in room , on the day of , 20 , at o'clock in the noon, and at any recessed Social Security Number: _____________________________________ or adjourned date, to testify and give evidence as a witness in this action on the part of the Name: ___________________________________________________ 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 Date of Birth: ________________________________ result of your failure to comply. Social Security Number: _____________________________________ Witness, Honorable , one of the Justices of the Court in County, day of , 20 Name: ___________________________________________________ Date of Birth: ________________________________ (Attorney must sign above and type name below) Social Security Number: _____________________________________ Attorney(s) for Name: ___________________________________________________ Date of Birth: ________________________________ Office and P.O. Address Social Security Number: _____________________________________ (Attach additional sheets if necessary) Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com