COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)UNITED STATES BANKRUPTCY COURT DISTRICT OF CONNECTICUT APPLICATION FOR APPOINTMENT OF ATTORNEYATTORNEYS ARE APPOINTED UNDER THIS COURT'S PRO BONO PROGRAM TO REPRESENT INDIVIDUAL DEBTORS IN CHAPTER 7 AND CHAPTER 13 CASES. IF YOUR APPLICATION FOR THE APPOINTMENT OF AN ATTORNEY IS GRANTED AND IF THE ATTORNEY ASSIGNED TO REPRESENT YOU DETERMINES THAT IT IS IN YOUR BEST INTEREST TO FILE A PETITION UNDER CHAPTER 13 AND A CHAPTER 13 PLAN IS FILED, YOUR ATTORNEY MAY REQUEST THE COURT TO ALLOW A REASONABLE FEE AND REIMBURSEMENT FOR ACTUAL, NECESSARY EXPENSES TO BE PAID OUT OF THAT PLAN.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOINSTRUCTIONSGREETINGS:1. If this is a joint application (filed by a husband and wife), each must provide all requested information. Please indicate by (H) and (W) if an answer to a particular question only applies to the husband or to the wife. 2. Attach additional sheets of paper if necessary. 3. Return this motion to: Clerk, United States Bankruptcy Court 915 Lafayette Boulevard Bridgeport, CT 06604WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour 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 result of your failure to comply.I. Personal/Financial Data, one of the Justices of theCourt in Witness, Honorableday of, 20 County,A. State your full name, present mailing address, and a telephone number: B. Do you presently have a pending bankruptcy case? If the answer is yes, state the location of the court and the bankruptcy case number C. Are you presently employed? If the answer is yes, state: (a) the kind of job(s) you have: (Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)(b) the name, address, and telephone number of your employer: (c) the amount of your usual weekly wages or salary: gross $ ; take home pay $ D. Are you self employed? If the answer is yes, state: (a) the kind of work you do: (b) the name, address, and telephone number of your business: (c) the amount of your ususal weekly income: gross $; take home pay $ E. If you are not presently employed or self employed state: (a) the name and address of your last employer: (b) when you last worked: (c) the amount of your last weekly wages, salary, or income: gross $ ; take home pay $ F. Approximately how much money have you received in the past twelve months from: (a) salary, wages, commissions, and other income: $ (b) interest, rent, and investments of any kind: $ (c) gifts, inheritance, and the sale of any property of any kind: (attach itemized list) $ G. Do you have any money in any checking, savings, credit union, or similar accounts? If the answer is yes, state: (a) the name and address of the depository (bank, credit union, etc): (b) your account number(s): (c) the amount of money in each account: $ H. Is any person, company, or governmental agency holding any money or property which you have a right to demand or receive? If the answer is yes, state: (a) the name and address of the person, company, or agency: (b) the basis for your claim: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour 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 result of your failure to comply., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)(c) the amount of money and/or a description of the property: J. Do you own any real estate or other property, excluding household items and clothing: If the answer is yes, describe the property: and state: (a) its location: (b) the approximate present value of each such item of property after deducting the current balance of all mortgages and other liens on that property: K. List each person who depends upon you for support and state your relationship to that person: L. Are there any persons regularly residing in your household who are over the age of eighteen and regularly employed? If the answer is yes, state as to each person: (a) name: (b) relationship to you: (c) name and address of employer: M. Itemize all household and living expense per month: (a) rent/mortgage payments:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any
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