COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. Which Financial Form -- FL-155 :or :
Index No. FL-150? Calendar No.
Answer these questions: (If any answer is yes, go to .) Are you self-employed?
: : : :
Yes Yes Yes Yes Yes Yes
JUDICIAL SUBPOENA No
No No No No No
Are you asking for spousal support or a change in spousal support? Is your spouse (husband or wife) asking for spousal support or a change in spousal support? attorney fees?
Defendant(s) Are you asking the other person to pay your : ......................................................
THE PEOPLE OF THE STATE OF NEW YORK
Is the other person asking you to pay his or her attorney fees?
TO Do you have income that is not listed below?
Welfare (CalWORKS, TANF, GR, or GA) Salary from your job GREETINGS: Disability Unemployment WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Worker's Compensation , the Honorable at the Court located at County Social Security of in room Retirement the , on day of , 20 , at o'clock in the noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
If you answered yes to at least one question, you must use FL-150 (Income and Expense Declaration). This form can be hard to fill out. Ask the Family Law Facilitator for help.
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 If you your failure to all of the result ofanswered noto comply. above, you can use FL-155 (Simplified Financial Statement)
or FL-150 (Income and Expense Declaration). But FL-155 is easier to fill out.
day of , 20
Witness, Honorable Court in County,
, one of the Justices of the
(Attorney must sign above and type name below)
Office and P.O. Address
Judicial Council of California www.courtinfo.ca.gov New January 1, 2003
Which Financial Form -- FL-155 or FL-150?
(Domestic Violence Prevention)
Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.:
DV-570, Page 1 of 1
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