COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.UNITED STATES DISTRICT COURT WESTERN DISTRICT OF LOUISIANAJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)(Name). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(Social Security #)THE PEOPLE OF THE STATE OF NEW YORK TOVS.U. S. Commissioner of Social SecurityGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableCOMPLAINT,located at County ofThe above-named plaintiff makes the following representations to this Court for the purpose of obtaining judicial review of a final decision of defendant adverse to plaintiff.The Court's jurisdiction of this cause is predicated on and invoked pursuant to 42 USC 405(g) to review a decision of the Commissioner of the Social Security Administration denying plaintiff's application. This action is an appeal from the final administrative decision denying plaintiff's claim. This action is commenced within the appropriate time period set form in the Action of Appeals Council on requests for Review. Plaintiff, whose Social Security account number iso'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), is a resident of the Parish of, State of Louisiana.Attorney(s) forPlaintiff complains of a decision that adversely affects plaintiff in whole or in part. The decision has become the final decision of defendant for purposes of review. The decision denying plaintiff's claim is contrary to the law and regulations, and the conclusions and findings of fact of the defendant are not support by substantial evidence.Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.WHEREFORE, plaintiff prays that this Court: Remand the case for further hearing;JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Allow the plaintiff to proceed and file this complaint without prepayment of costs.Order such other and further relief s the Court deems just and proper.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .day of, 20.Dated thisTHE PEOPLE OF THE STATE OF NEW YORK TORESPECTFULLY SUBMITTED:GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,Phone Number: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 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.com
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