COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : : Plaintiff(s) -against- Calendar No. JUDICIAL SUBPOENA : : : Defendant(s) : ...................................................... COURT OF WASHINGTON FOR THE PEOPLE OF THE STATE OF NEW YORK NO. TO Petitioner vs. GREETINGS: Respondent MOTION FOR WAIVER OF FEES PURSUANT TO RCW 10.14.(Ch. 117 L 2002 § 2) - HARASSMENT (MT) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before I. MOTION , the Honorable at the Court Based on the declaration below, I movelocated at an order waiving filing fees, court costs and service fees that may the court for County of be charged by a public agency. in room , on the day of , 20 , at o'clock in the noon, and at any recessed II. as a witness in this or adjourned date, to testify and give evidenceDECLARATION action on the part of the I am seeking protection for myself, or for a minor, from the respondent who: Stalking: intentionally and repeatedly harasses or repeatedly follows me causing me to fear the respondent Your failure to comply with this subpoena is punishable as a reasonably should and I will be intends to injure me, another person or property; and the respondent intends orcontempt of courtknowwill make you liable to the party intimidated, or harassed. [See RCW 9A.46.110] frightened, 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. Sex offense: engaged in conduct that amounts to a sex offense such as rape, child molestation, indecent liberties; family offenses, such as incest; sexual exploitation of children offenses, such as communication with a minor for Witness, Honorable , or a felony that was immoral purpose; or attempt, solicitation or conspiracy to commit one of those crimes;one of the Justices of the committed in part for the County, sexual gratification. [See ,RCW 9A.44.130] offender’s Court in day of 20 Domestic violence: engaged in conduct that includes physical harm, bodily injury, assault, stalking, or inflicting fear of imminent physical harm, bodily injury or assault involving a family or household member. Check the box that describes your relationship to the respondent: Spouse Former spouse Parent or child In-law (Attorney must sign above and type name below) Related by blood Have child in common Presently reside together Resided together in past Presently dating Dated in past. [See RCW 26.50.010] The factual bases for this declaration are found in the statement filed with the Petition for Order for Protection and Attorney(s) for incorporated by reference. I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Dated __________________________ at ________________________________ [City], Washington. Office and P.O. Address Petitioner Telephone No.: MT FOR WAIVER OF FEES - RCW 10.14 (Ch. 117 L 2002 § 2)- HARASSMENT (MT) - Page 1 of 1 UH-02.0150 (6/2002) - RCW 10.14. (Ch. 117 L 2002 § 2) Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com