COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.STATE OF OHIOIN THE COMMON PLEAS COURTCOUNTY OF CUYAHOGAJUVENILE COURT DIVISIONCalendar No.MEDICAL CERTIFICATEJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)IN THE MATTER OFCASE NUMBER:BELIEVED TO BE A ( )DEPENDENT ( )NEGLECTED CHILD, a reputable practicing physician,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .deposes and says that the following statements are true to the best of his/her knowledge and belief:, a minor child born on, was admitted to1)hospital under the care of the undersigned on.THE PEOPLE OF THE STATE OF NEW YORK TOyears of age, and has been diagnosed as follows:2) Said child is now.GREETINGS:3) As a result of such diagnosis, the following medical and/or surgical treatment is immediately necessary in order to preserve said child=s life: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 room.AFFIANTYour 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.STATE OF OHIO COUNTY OF CUYAHOGA, one of the Justices of theCourt in Witness, Honorableday of, 20 County,day ofSworn to before me and subscribed in my presence this, 20.(Attorney must sign above and type name below)Notary Public/Deputy ClerkAttorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com
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