COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IN THE PROBATE COURT OF MAHONING COUNTY, OHIO:::::::Index No.JUDGE TIMOTHY P. MALONEYCalendar No.IN THE MATTER OF THECASE NO.: G REGISTRATION OF THE BIRTH OF:JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)G CORRECTION OF BIRTH RECORD:OF/FOR: DEPOSITION AND INTERROGATORIES BY COMMISSIONER*[Revised Code ยง3705.15 (B) and Local Rule 75.6]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Deposition of witness/applicant, taken before me, , the duly appointed Commissioner herein, a for the County of , State of .THE PEOPLE OF THE STATE OF NEW YORK TOPursuant to the attached commission issued to me, I caused the witness/applicant to appear personally before me on , 20 , at , and after being first duly cautioned and sworn [or affirmed] by me, answered the following interrogatories:GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable1. What is your full name? Answer ,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 room2. What was the full name of applicant at time of birth? (Give first, middle and surname) Answer 3. What was the exact place of birth of applicant? Answer 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.4. What was the month, day and year of applicant's birth? Answer 5. What was the sex of the applicant at the time of his/her birth? [NOTE: For Corrections, you must obtain and attach a certified, exemplified or authenticated copy of the original certificate of birth for the applicant.] Answer , one of the Justices of theCourt in Witness, Honorableday of, 20 County,6. What was the full name of applicant's father? Answer (Attorney must sign above and type name below)7. What was the birth father's age at the time of applicant's birth? Answer Attorney(s) for8. Where was the birth father born? (City, Town or county) -(State or foreign country) Answer 9. What was the full maiden name of applicant's mother? Answer 10. What was the birth mother's age at the time of applicant's birth? Answer 11. Where was the birth mother born? (City, Town or county) -(State or foreign country) Answer Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Form 75.6 (A) (2) M.C.-bRevised 09-11-02Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.12. What documents, if any, do you submit as exhibits, and in what ways do they support the allegations of the application. [Certified copies of original or photostatic copies of the documents submitted should be attached and properly marked as exhibits.] Answer JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Signature of Witness/Applicant Typed or Printed name AddressCity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOStateZipArea Code/PhoneCERTIFICATE OF COMMISSIONERGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableI, , certify that I ama for the aforesaid State and County and was duly acting and qualified as the commissioner at the time of the taking of the attached deposition, and further certify that the foregoing deposition of was taken before me at the time and place and for the purpose specified in the commission. I further certify that deponent was first duly sworn to testify truthfully; that the deposition was reduced to writing by me, in the presenceofthedeponentandwassubscribedbythedeponentinmypresence.,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 $50 and all damages sustained as a result of your failure to comply.I further certify that I am not a counsel or relative of the applicant, or witness, nor am I otherwise interested in the proceedings.[SEAL], one of the Justices of theCourt in Witness, Honorableday of, 20 County,Date:Commissioner's SignatureTyped or Printed Name(Attorney must sign above and type name below)Commissioner's Fees:$Witness Fees$AddressAttorney(s) forTotal$CityZipStateArea Code/PhoneOffice and P.O. Address[*NOTE: A separate Deposition must be completed for each applicant/witness].Telephone No.: Facsimile No.: E-Mail Address:Form 75.6 (A)(2) M. C. -bRevised 09-11-02Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com
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