COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.JUDICIAL SUBPOENAPlaintiff(s)-against-Defendant(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOSUPERIOR COURT OF WASHINGTON COUNTY OF JUVENILE COURT STATE OF WASHINGTON v.NO:WAIVER OF LAWYER BY PARENT/GUARDIAN/CUSTODIAN (WVC)Respondent(s). D.O.B.:GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,The undersigned states that: 1.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 roomI have been informed and fully understand that I have the right to be represented by a lawyer in these proceedings;2.I have been informed and fully understand that if I am unable to pay for a lawyer, one will be provided for me without charge;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.3.I freely and voluntarily give up my right to be represented by a lawyer.Dated: SignatureTitle, one of the Justices of theCourt in Witness, Honorableday of, 20 County,Dated: SignatureTitle(Attorney must sign above and type name below)JUDGE'S CERTIFICATEAttorney(s) forThe foregoing statement was read by or to the requesting parent guardian/custodian and was signed in the presence of the undersigned judge in open court. The court finds the waiver of a lawyer to be knowingly, intelligently, and voluntarily made. Dated: JUDGE/COMMISSIONEROffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:WAIVER OF LAWYER (PARENT/GUARDIAN/CHILD) (WVC) -Page 1 of 1 WPF JU 09.0200 (9/2000) -RCW 13.32A.160; 13.34.090; 13.40.080, .140Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com
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