Request For Accommodations By Persons With Disabilities And Order
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Request For Accommodations By Persons With Disabilities And Order Form. This is a Washington form and can be use in Clark Local County.
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REQUEST FOR ACCOMMODATIONS BY PERSONS WITH
-against-DISABILITIES and ORDER
FORM TO BE KEPT CONFIDENTIAL (If box checked)
Applicant requests accommodation under Local Rule 0.4(b)
Applicant is: _ Witness
THE PEOPLE OF THE STATE OF NEW YORK
Type COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
WE of proceeding.
Proceedings to be covered (e.g., bail hearing, preliminary hearing, particular witnesses at trial,
, on the
o'clock in the
noon, and at any recessed
Dates accommodations needed (specify):
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Impairment necessitating accommodations (specify):
Type of accommodations (be specific):
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the partySpecial requests orthis subpoena was issued for a maximum penalty of $50 and all damages sustained as a
on whose behalf anticipated problems (specify):
result of Iyour failure tomy identity
_ not be kept confidential
request that comply.
_ be kept confidential
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and
, one of the Justices of the
correct. Witness, Honorable
(Attorney must sign of Applicant)name below)
(Signature above and type
(Type or print name)
_ The request for accommodations is GRANTED because:
__ he applicant satisfies the requirements of the rule.
_ it does not create an undue burden on the court.
_ it does not fundamentally alter the nature of the service; program or activity
Office and P.O. Address
_ The request for accommodations is DENIED because:
___ the applicant does not satisfy the requirements of the rule.
_ it creates an undue burden on the court.
___ it fundamentally alters the nature of the service, program or activity. No.:
Mobile Tel. No.:
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