COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Probate .Court Form No. 34 .... .. .. : Written Statement of Claim Index No. : Calendar No. PROBATE COURT : STATE OF VERMONT DISTRICT OF _______________________ Plaintiff(s) JUDICIAL SUBPOENA -against- : DOCKET NO. __________________ : IN RE THE ESTATE OF _______________________________ LATE OF ______________________ : Defendant(s) : ...................................................... WRITTEN STATEMENT OF CLAIM Directions: THE PEOPLE OF THE STATE OF NEW YORK Describe in the space provided below your claim against the above named estate. The statement must include the TO basis of the claim, the amount claimed, and a written description of the claim. You must attach a copy of any documentation. If the claim is contingent or unliquidated, the nature of the uncertainty must be described. If the claim is secured, you must describe the security. You must file this claim by delivering or mailing it to the executor or administrator of the estate and filing a duplicate with the Register of the GREETINGS: Probate Court. WE COMMAND YOU, that all business Name and Address of Executor or Administrator: and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of Name: ___________________________________ inAddress: _________________________________ 20 room , on the day of , , 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 Telephone: (____) _________________________ Address of Probate 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 Probate Court, District of _______________________ result of your failure to comply. _______________________ _______________________ Witness, Honorable _______________________ Court in County, , one of the Justices of the day of Dated: __________________________ , 20 (Attorney must sign above and type name below) Signed _________________________________ Print Name: _____________________________ Attorney(s) for Address: __________________________________ _______________________________________ Telephone: (____) ________________________ Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com