Affidavit Of Indigency

<document>COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.IN THE COMMON PLEAS COURT OF ERIE COUNTY, OHIO PROBATE DIVISIONJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)* IN THE MATTER OF*CASE NO. * THE GUARDIANSHIP OF*AFFIDAVIT OF INDIGENCY *** * * * * * * * * * * * * * * * * *. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOSTATE OF OHIO))ss: ERIE COUNTY )GREETINGS:The undersigned being first duly sworn states under oath that the ward's only incomeWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,is $ per and the ward's total assets are less than criteria for a Medicaid Recipient and due to these circumstances is without funds to pay attorney fees for these proceedings.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.Guardian, one of the Justices of theCourt in Witness, Honorableday of, 20 County,Sworn to and subscribed in my presence this day of , 20.(Attorney must sign above and type name below)Notary Public or Deputy ClerkAttorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com</document>