COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.PROBATE COURT OF HAMILTON COUNTY, OHIOCalendar No.JAMES CISSELL, JUDGEJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)ADOPTION OF(Name after adoption) CASE NO.AFFIDAVIT(R.C. 3109.27). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .State of Ohio, County ofS.S.Upon being duly sworn.does hereby state the following:(Name)THE PEOPLE OF THE STATE OF NEW YORK TO1. The child(ren) involved is/are2. The child(ren)'s present address is/areGREETINGS:3. The places where the child(ren) has/have lived the last five years areWE 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 room4. The names and present addresses of the persons with whom the child(ren) has/have lived during that period is/are 5. I have/have not participated as a party, witness, or in any other capacity or any other litigation concerning the allocation of parental rights and responsibilities of the same child(ren) or that otherwise concerned the custody in this or any other State. 6. I have/have no information of any parenting proceeding concerning the child(ren) pending in a court of this or any other State. 7. I know/do not know person(s) not a party to the proceeding concerning the child(ren) or claims to be a parent of the child(ren) who is designated the residential parent and legal custodian of the child(ren or to have visitation rights with respect to the child(ren) or any person other than a parent of the child(ren) who has custody or visitation rights with respect to the child(ren). 8. I have/have not been convicted of or pleaded guilty to any criminal offense involving any act that resulted in a child being abused or neglected nor have I been the perpetrator of the abusive or neglectful act that was the basis of an adjudication that a child is an abused or neglected child. If your declarations in statements 5 through 8 are in the affirmative, state the case name(s), case number(s), date(s) and nature of the cases(s)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 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. Addressday of Sworn to before me and subscribed in my presence this,.Telephone No.: Facsimile No.: E-Mail Address:Notary PublicMobile Tel. No.:02/10/03H.C. FORM 118.10 -AFFIDAVITAmerican LegalNet, Inc. www.USCourtForms.com
|
Get this form for FREE as a print-only pdf
