COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.IN THE COMMON PLEAS COURT OF WARREN COUNTY, OHIO JUVENILE DIVISIONJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Case No.Plaintiff/Petitioner(1))CSEA No.DOBAddressMIKE POWELL)JUDGE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V.)MAGISTRATETHE PEOPLE OF THE STATE OF NEW YORK TODefendant/Petitioner(2)/RespondentAffidavitofIncomeand Expenses ofGREETINGS:DOB Address(Name)WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,Date of Determination Of Parentagelocated 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.Notes: This affidavit must be filed and served in accordance with Local Rules of Court. This affidavit must be filed and served with every motion that concerns a modification of support. You will be required to provide proof of income per local rule and O.R.C. 3113.215(B)(5). You are under a continuing legal duty to file an updated version of this form if you learn of any additional information. If more space is needed, attach additional page(s). I. Income [As defined in O.R.C. 3113.215(A)]: A. Gross Yearly Income from Employment (If not known, please estimate. Put EST after each estimated figure.), one of the Justices of theCourt in Witness, Honorableday of, 20 County,MotherFatherGross Yearly Employment Income EmployerPayroll Address City, State, Zip Check the number of Paychecks per year(Attorney must sign above and type name below)Attorney(s) for 12 24 26 52 12 24 26 52Office and P.O. AddressYear-to-date Gross IncomeThrough date ofThrough date ofPrior Year's Tax RefundTelephone No.: Facsimile No.: E-Mail Address:WCJC Form 1 Eff. 6/1/02Mobile Tel. No.:Financial Disclosure Affidavit Page 1Initialed American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.B.JUDICIAL SUBPOENAPlaintiff(s)Annual Overtime, Commissions, Bonuses (If not known, please estimate. Put EST after each estimated figure.)-against-FatherMotherYear 3 is Most Recent YearOvertime,Commission,BonusesYear 3 is Most Recent YearOvertime,Commission,BonusesDefendant(s)Base IncomeBase Income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Year 120Year 120Year 220Year 2THE PEOPLE OF THE STATE OF NEW YORK TO20Year 320Year 3Y-T-D This Year Through:Y-T-D This Year Through:GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,C. Gross Self-Employment Income (If not known, please estimate. Put EST after each estimated figure.)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 roomUse Gross Annual Figures for Most Recent Full Year. See O.R.C. 3113.215(A)FatherMotherBusiness Receipts Ordinary & Necessary Business Expenses Net Business IncomeYour 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,D. Other Income All other income, actual or expected, including pension, social security, workers compensation, commissions, royalties, disability benefits, trust income, annuities, reoccurring capital gains, unemployment benefits, rents, expense-sharing, dividends, interest, AFDC, SSI, food stamps, spousal support received from a prior spouse, etc. (If not known, please estimate. Put EST after each estimated figure.)(Attorney must sign above and type name below)FatherMotherAttorney(s) forDescribePer YearDescribePer YearOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:WCJC Form 1 Eff. 6/1/02Mobile Tel. No.:Financial Disclosure Affidavit Page 2Initialed American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.E. Total Annual IncomeJUDICIAL SUBPOENAFatherMotherPlaintiff(s) -against-Defendant(s)Total gross annual incomeTotal gross annual incomeTotal average gross monthly incomeTotal average gross monthly income 12 = 12 =Average monthly deductionsLessAverage monthly deductionsLess. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Total net monthly income=Total net monthly income=THE PEOPLE OF THE STATE OF NEW YORK TOF. Benefits of Employment (Use of company car, country club memberships, stock options, etc.)FatherMotherGREETINGS:BenefitsValuesBenefitsValuesWE 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 roomII. Information Required for Support Calculation: A. Minor or Dependent Children of these PartiesYour 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.(Include any child of the parties who is over 18 and handicapped)Child's NameDate of BirthResiding with, one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)B. Other Minor Children Living in My HouseholdChild's NameRelationshipDate of BirthAttorney(s) forOffice and P.O. AddressC. Other Minor Children of Mine, Not Living in M
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