COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. : Calendar No. ADDENDUM TO CONFIDENTIAL INFORMATION FORM (AD) : JUDICIAL SUBPOENA Plaintiff(s) Cause Number: Do not file in a -against: public access file. COURT CLERK: THIS IS A RESTRICTED ACCESS DOCUMENT County: The following information about additional parties is required in all cases. : Additional Petitioner Information Type or Print only Name (Last, First, Middle) Additional Respondent Information : Name (Last, first, Middle) Defendant(s) : . . . . . . Race. . . . . . . . . . Sex . . . . . . . .Birthdate. . . . . . . . . . . . .Race . . ... ... ...... ... Drivers Lic. or Identicard (# and State) THE PEOPLE OF THE STATE OF NEW YORK Sex Birthdate Drivers Lic. or Identicard (# and State), (or, if unavailable, residential address) TO Mailing Address (P.O. Box/Street, City, State, Zip) Mailing Address (P.O. Box/Street, City, State, Zip) Relationship to Child(ren) Relationship to Child(ren) GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before The following information is required if there are additional children involved in the proceeding , the HonorableNo. is not required for petitions in protection order cases (Domestic Violence/Antiharassment). at the Court (Soc. Sec. located at County of 3) Child's Name (Last, First, Middle) in room , on the day of , 20 , at o'clock in the noon, and at any recessed Child's Race/Sex/Birthdate or adjourned date, to testify and give evidence as a witness in this action on the part of the Child's Soc. Sec. No. (If required) Child's Present Address or Whereabouts Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 4) Child's Name (Last, First, Middle) the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Child's Race/Sex/Birthdate result of your failure to comply. Child's Soc. Sec. No. (If required) Witness, Honorable Child's Present Address or Whereabouts Court in County, , one of the Justices of the day of , 20 Except for petitions in protection order cases (Domestic Violence/Antiharassment), the following information is required: Additional Petitioner Information Additional Respondent Information below) (Attorney must sign above and type name Soc. Sec. No.: Residential Address (Street, City, State, Zip) Soc. Sec. No.: Residential Address (Street, City, State, Zip) Attorney(s) for Telephone No.: ( ) Telephone No.: ( ) Employer: Employer: Empl. Address: Empl. Address: Office and P.O. Address Empl. Phone No.: ( ) Empl. Phone No.: ( ) Telephone No.: WPF DV-1.0610 Conf. Info. Form Addendum (AD) (12/2001) - Page 1 of 1 Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com