COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. DO NOT SERVE OR SHOW THIS SHEET TO THE RESTRAINED PERSON COURT CLERKS: Give this form to Law Enforcement. Case Number : Calendar No. DO NOT FILE in the court file. Domestic Violence Dissolution/Separation/Invalidity/Nonparental Custody/Paternity : Antiharassment JUDICIAL SUBPOENA Plaintiff(s) LAW ENFORCEMENT INFORMATION -against: This completed form is required by law enforcement. This information is necessary to serve, enforce and enter your order into the state wide law enforcement computer. Fill in the following information as completely as possible. Type or print only. : Name of Restrained Person (Last, First, Middle) RESTRAINED PERSON’S INFORMATION Nickname Drivers License or ID Number (specify type) : Defendant(s) : ...................................................... Weight Height Eye Color Hair Color Skin Tone Sex Race Build Relation to Protected Person Home Phone Last Known Address (Street, City, State, Zip) THE PEOPLE OF THE STATE OF NEW YORK Birth date Interpreter Required? Language: TO Other Address (Street, City, State, Zip), if any: Employer Employer's Address GREETINGS:Number Vehicle License WORK Hours: Phone: Vehicle Color Vehicle Make and Model Vehicle Year WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Name of Protected Person (Last, First, Middle) , the Honorable at the Court PROTECTED PERSON’S located at County of INFORMATION in room Sex , on the day of , 20 , at o'clock in the noon,date at any recessed Race Birth and or adjourned date, to testify and give evidence as a witness in this action on the part of the If your information is not confidential, enter your address and phone number(s). Current Address (Street, City, State, Zip) Phone Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to If your informationon confidential, you may provide the name, address a maximum penaltysomeoneand all to be your sustained as a the party is whose behalf this subpoena was issued for and phone number of of $50 willing damages “contact.” Contact your result ofName failure to comply. Witness, Honorable MINOR’S INFORMATION Court in County, Minor’s Name (Last, First, Middle) Contact Address Contact Phone , one of the Justices of the Describe the minor’s relationship using terms such day of child, grandchild, stepchild, nephew, none. à , 20 as: Sex Race Birth date Resides With Minor’s Relationship to Protected Restrained Person Person (Attorney must sign above and type name below) HAZARD INFORMATION Weapons Guns/Rifles Knives Explosives Attorney(s) for Other Location of Weapons: Describe in detail: Vehicle On Person Residence CURRENT STATUS (For DV Orders Only) (circle) Are you and the restrained person living together right now? Yes Does the restrained person know you are trying to get this order? Yes Does the restrained person know he/she may be moved out of home? Yes Is the restrained person likely to react violently when served? Yes Prepared by: See Reverse For Additional Information UH-01.0400 LEIS (6/2002) Office and P.O. Address Restrained Person’s History Includes: No No No No Mental Health Problems (Commitment, Treatment, Suicide Assault Assault with Weapons Attempt, Other) Alcohol/Drug Abuse Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Date American LegalNet, Inc. www.USCourtForms.com