COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Plaintiff(s) -against- Calendar No. : JUDICIAL SUBPOENA : : : Defendant(s) : ...................................................... CONFIDENTIAL INFORMATION FORM (INFO) County: Cause Number: THE PEOPLE OF THE STATE OF NEW YORK Do not file in a COURT CLERK: THIS IS A RESTRICTED ACCESS DOCUMENT public access file. TO Divorce/Separation/Invalidity/Nonparental Custody/Paternity/Modifications Other Domestic Violence Antiharassment Information Change (Check if you are updating information) A restraining order or protection order is in effect protecting the petitioner the respondent the children. GREETINGS: The health, safety, or liberty of a party or child would be jeopardized by disclosure of address information COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before WE because: , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the The following information about the parties is required in all cases: noon, and at any recessed or adjournedthe Addendum To Confidential Information Formthislist additional part of thechildren) (Use date, to testify and give evidence as a witness in to action on the parties or Petitioner Information Respondent Information Type or Print only Name (Last, First, Middle) Name (Last, First, Middle) 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 Race Sex Birthdate Race Sex Birthdate result of your failure to comply. Driver’s Lic. or Identicard (# and State) Witness, Honorable Court in County, day of Mailing Address (P.O. Box/Street, City, State, Zip) Driver’s Lic. or Identicard (# and State), (or, if unavailable, residential address)of the Justices of the , one , 20 Mailing Address (P.O. Box/Street, City, State, Zip) (Attorney must sign above and type name below) Relationship to Child(ren) Relationship to Child(ren) Attorney(s) for The following information is required if there are children involved in the proceeding. (Soc. Sec. No. is not required for petitions in protection order cases (Domestic Violence/Antiharassment). 1) Child's Name (Last, First, Middle) Child's Race/Sex/Birthdate Child's Soc. Sec. No. (If required) Child's Present Address or Whereabouts Office and P.O. Address Telephone No.: No.: E-Mail Address: Mobile Tel. No.: WPF DV-1.060 Confidential Information Form (INFO) (12/2001) - Page 1 ofFacsimile 2 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : 2) Child's Name (Last, First, Middle) Plaintiff(s) Child's Race/Sex/Birthdate -against- Calendar No. : JUDICIAL SUBPOENA Child's Soc. Sec. No. (If required) : Child's Present Address or Whereabouts : : List the names and present addresses of the persons with whom the child(ren) lived during the last five years: Defendant(s) : ...................................................... List the names and present addresses of any person besides you and the respondent who has physical custody of, or claims rights of custody or YORK THE PEOPLE OF THE STATE OF NEW visitation with, the child(ren): TO Except for petitions in protection order cases (Domestic Violence/Antiharassment), the following information is required: GREETINGS: Petitioner's Information Respondent's Information WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Soc. Sec. No.: Soc. Sec. No.: , the Honorable at the Court Residential Residential Address (Street, City, State, Zip) located at County of Address (Street, City, State, Zip) in room , on the day of , 20 , 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 No.: ( ) Telephone No.: ( ) Employer: Employer: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Empl. Address: the party on whose behalf this subpoena was issuedEmpl. maximum penalty of $50 and all damages sustained as a for a Address: result of your failure to comply. Empl. Phone No.: ( ) Witness, Honorable Court in County, Additional information: Empl. Phone No.: ( day of ) , one of the Justices of the , 20 (Attorney must sign above and type name below) Addendum To Confidential Information Form is attached. I certify under penalty of perjury under the laws of the state of Washington for the above information is Attorney(s) that true and accurate concerning myself and is accurate to the best of my knowledge as to the other party, or is unavailable. The information is unavailable because . Signed on __________________ (Date) at ____________________________________ (City and State). Office and P.O. Address Petitioner/Respondent Telephone No.: WPF DV-1.060 Confidential Information Form (INFO) (12/2001) - Page 2 ofFacsimile No.: 2 E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com