. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Page of THE PEOPLE OF THE STATE OF NEW YORK TOUnified Judicial System Disposal Log Non-Permanent Records1. County2. Judicial District3. Record Custodian4. Office/Department5. Address6. Telephone No.GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable7.9.12. 8.11.10.,AUTHORIZATION FOR DISPOSALlocated at County ofMICRO-FILMED(Y-N), on the, at or adjourned date, to testify and give evidence as a witnessDATESin this action on the part of the, 20noon, and at any recessed in roomo'clock in the day ofORIGINAL(Y-N)INCLUSIVEOF RECORDSSCHEDULE [ยง Name (e.g. 5.7 Juvenile)]RECORD TITLEFORMATYour 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, Honorable, 20 County,day of(Attorney must sign above and type name below)FOR USE BY RECORD CUSTODIANI, , hereby request that the Record Retention Officer authorize the disposal of the listed records. Record Custodian's NameAttorney(s) for Record Custodian's SignatureDateTitleFOR USE BY RECORD RETENTION OFFICEROffice and P.O. AddressI, , hereby approve of the disposal of the records listed as requested. Record Retention Officer's NameTelephone No.: Facsimile No.: beE-Mail Address: Record Retention Officer's SignatureDateTitleprovided to the AOPC on or before January 15th each year.Original to be retained by the District Record Retention Officer. Copy to be provided to the Record Custodian. Copy toMobile Tel. No.:AOPC 507BAmerican LegalNet, Inc. www.USCourtForms.com
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