COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.INSTRUCTIONS: FILLING OUT THE AFFIDAVIT OF PERSON TO BE APPOINTEDGUARDIAN AND/OR CONSERVATORJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)STEP 1:FILL OUT THE AFFIDAVIT OF PERSON TO BE APPOINTED GUARDIAN AND/OR CONSERVATOR(1)Enter your name; street address; city, state, and zip code; and phone number.(2)Enter the name of the proposed ward and/or protected person, and check the box indicating that the person is an adult.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(3)For Numbers 1-15, check the appropriate box indicating whether each statement is true or false. Fill in the blanks for Number 9 and 10. Each answer that is false must be explained in writing in an attachment to this Affidavit (see FILL OUT THE ATTACHMENT TO THE AFFIDAVIT, below).THE PEOPLE OF THE STATE OF NEW YORK TO(4)Fill in the blanks.GREETINGS:Do not sign the Affidavit until you have it notarized (see HAVE THE PETITION AND AFFIDAVIT NOTARIZED, below).WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,STEP 2:FILL OUT THE ATTACHMENT TO THE AFFIDAVITlocated 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 roomYou must attach to the Affidavit an explanation of each "False" you entered in Numbers 1-15 of the Affidavit. The Attachment is part of the Affidavit, and you are still under oath when you fill it out.At the top of a blank piece of paper, type or print "ATTACHMENT TO THE AFFIDAVIT OF PERSON TO BE APPOINTED GUARDIAN AND/OR CONSERVATOR". Then type or print the following information for the corresponding Numbers on the Affidavit. List the information only for the Numbers you listed as "False" on the Affidavit.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,1.For each felony you have been convicted of, list: a.The nature of the offense b.(Attorney must sign above and type name below)The name and address of the sentencing court c.The case number d.The date of conviction e.Attorney(s) forThe terms of the sentence f.The name and phone number of any current probation or parole officer g.The reasons the conviction should not disqualify you from appointment2.If you have acted as a guardian or conservator within 3 years before filing this Petition, list: a.Office and P.O. AddressThe names of the individuals for whom you are currently serving and the court case numbers. b.The names of the individuals for whom your appointment has been terminated within the 3-year period and the court case numbers.Telephone No.: Facsimile No.: E-Mail Address:Page 1 of 2 Revised September 2002Mobile Tel. No.:Coconino County Law Library and Self-Help Center FormsAmerican LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.3.If you do not understand the powers and duties, state how you intend to obtain this information.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)4.State the total number of persons for whom you have had power of attorney within 3 years before filing this Petition. If you have acted under a power of attorney for the proposed ward and/or protected person, list: a.The date the power of attorney was signed b.Where it was signed c.The actions you have taken pursuant to the power of attorney d.Whether the power of attorney is currently in effect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5.State why you are listed in the Elder Abuse Registry.THE PEOPLE OF THE STATE OF NEW YORK TO6.List the name of each business and the reason each is listed in the Elder Abuse Registry.7.List the name and location of the court and the name and case number of the files in which you were delinquent in filing the required report.GREETINGS:8.List the name and location of the court, the name and case number of each file, and the circumstances of your removal.WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,11.State the number of occasions on which you received such gifts; list the gifts, the dates they were received, and the value of each; and describe the gifts.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 room12.State the number of occasions on which the business received such gifts; list the gifts, the dates they were received, and the value of each; and describe the gifts.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.13.State the number of occasions on which you have been so named.14.State the number of occasions on which the business was named., one of the Justices of theCourt in Witness, Honorableday of, 20 County,15.List the name and address of each business and the extent and nature of your interest.STEP 3:HAVE THE PETITION AND AFFIDAVIT NOTARIZED(Attorney must sign above and type name below)After completing Steps 1 and 2, take the Petition and Affidavit and a photo ID to a notary public. Date and sign the Petition and Affidavit in front of the notary. The notary will fill out the Notarization sections.Attorney(s) forA notary public is a person authorized by the state to administer oaths, certify documents, and attest to the authenticity of signatures. You can find a notary at most banks or listed in the Yellow Pages. Notaries usually charge a small fee.Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Page 2 of 2 Revised September 2002Mobile Tel. No.:Coconino County Law Library and Self-Help Center FormsAmerican LegalNet, Inc. www.USCo
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