COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Rev.7/93Calendar No.UNITED STATES DISTRICT COURTJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)WESTERN DISTRICT OF LOUISIANAPlaintiff. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .versusCivilActionNo./DefendantJudgeMag.JudgeTHE PEOPLE OF THE STATE OF NEW YORK TOAPPLICATIONTOPROCEEDINFORMAPAUPERIS UNDERSECTION706(f)OFCIVILRIGHTSACTOF1964GREETINGS:1.FULLNAMEWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable2.ADDRESS,(StreetAddressorP.O.Box)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 room(City)(State)(ZipCode)3.MARITALSTATUS:SingleMarriedSeparatedDivorcedWidowedYour 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.Areyoupresentlyemployed?YesNoIf the answer is "yes," give your occupation, the name and address of your employer and the gross and net amount of your salary., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Occupation)(NetSalary)(GrossSalary)(Attorney must sign above and type name below)(NameandaddressofYouremployer)Attorney(s) for5.If you are not presently employed, state the date of your last employment, the name and address of your employer and your salary.Office and P.O. Address(Salary)(Datelastemployed)Telephone No.: Facsimile No.: E-Mail Address:(NameandAddressoflastEmployer)1Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.6.Ifyouaremarriedandifyourspouseisemployed,statehis/her name,occupation,employer,addressofemployerandsalary.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)(Nameofspouse)(Occupation)(Salary)7.Approximatelyhowmuchmoneyhaveyoureceivedinthepasttwelve monthsfromthefollowingsources:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .aswages,salary,commissionsorearnedincomeofanykind?asworkman'scompensationordisabilityinsurance?THE PEOPLE OF THE STATE OF NEW YORK TOasrentpayments,interest,dividends?aspensions,annuitiesorlifeinsurancepayments?GREETINGS:fromsocialsecurity,unemploymentcompensationwelfareorWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorablepayments?,located at County ofasgiftsorinheritance?o'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 roomfromothersources?8.How much money do you own or have in any checking or savings account?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.9.Doyouownorhaveanyinterestinanyrealestate,automobiles or other vehicles, boats, stocks, bonds, notes, or any other valuableproperty(excludingordinaryhouseholdfurnishingsand clothing)?, one of the Justices of theYesNoCourt in Witness, Honorableday of, 20 County,If "yes", give a description of the property and its estimated value.(Attorney must sign above and type name below)Attorney(s) for10.Isanyonedependentonyouforsupport?NoYesIf"yes",givenames,ages,relationshiptoyou,andtheamount youcontributetowardtheirsupport.Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:2American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.11.Listanydebtsyouhaveandtheamountowed.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)CreditorAmountOwed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12.Listyourmonthlylivingexpenses.THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:Icertifyunderpenaltyofperjurythattheaboveinformationis trueandcorrecttothebestofmyknowledge.WE 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 of(SignatureofApplicant)o'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., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com3
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