COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF OHIO DIVISIONJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s),Plaintiff, vs.CASE NO.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,Defendant.THE PEOPLE OF THE STATE OF NEW YORK TOCOMPLAINTThe above named plaintiff make the following representations to this court for the purpose of obtaining judicial review of a decision of the defendant adverse to the plaintiff.GREETINGS:1.The plaintiff (whose Social Security Account No. is is a resident of , . CityWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableState 2.,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 roomThe plaintiff complains of a decision which adversely affect the plaintiff in whole or in part. The decision has become the final decision of the Secretary for purposes of judicial review and bears the following caption: In the case ofClaim forYour 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. Claimant Wage Earner, one of the Justices of theSocial Security NumberCourt in Witness, Honorableday of, 20 County,3.(Attorney must sign above and type name below)The plaintiff has exhausted administrative remedies in this matter and this court has jurisdiction for judicial review pursuant to 42 U.S.C. Section 405(g). Wherefore, plaintiff seeks judicial review by this court and the entry of judgment for such relief as may be proper, including costs.Attorney(s) forPlaintiff DateAddressTelephoneOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com
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