COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. GOVERNMENTAL AGENCY (under Family Code, §§ 1740 and 17406): TELEPHONE NO.: : Index No. :
TELEPHONE NO.: ATTORNEY FOR (Name): FAX NO.:
FOR COURT USE ONLY
: : : :
SUPERIOR COURT OF CALIFORNIA, COUNTY OF -againstSTREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:
PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: . . . . . . . . . . . .PARENT: . OTHER . . . . . .
Defendant(s) : ...................................
THE PEOPLE OF THE STATE OF NEW YORK TO
DECLARATION FOR DEFAULT OR UNCONTESTED JUDGMENT (Governmental)
1. I declare that if I appeared in court and were sworn, I would testify to the truth of the facts in this declaration. 2. Proof will be by this declaration and I will not appear before the court unless I am ordered by the court to do so. 3. All the information in the complaint is true and correct according to the records maintained by the local child support agency under the Social Security Act.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court 4. The default of the respondent/defendant was entered or is being requested and the petitioner/plaintiff is only seeking the relief located at County of complaint as originally filed or amended. requested in the in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, order is requested, attach support information. Include the best estimate of the defendant's income.) to testify and give evidence as a witness in this action on the part of the 5. SUPPORT (If a support
Child support Health Insurance should be ordered as set forth in the proposed Judgment (Governmental).
6. PUBLIC ASSISTANCE The children are receiving the party on whose behalf this subpoena was issued receiving nor applying for public assistance. 7. Any support ordered should be payable to (specify):
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to formerly received are neither are applying for for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. , one of the Justices of the day of , 20
Witness, Honorable Court in County,
8. Other (specify):
(Attorney must sign above and type name below)
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Office and P.O. Address
(TYPE OR PRINT NAME)
Form Adopted for Mandatory Use Judicial Council of California FL-697 [Rev. January 1, 2003]
Telephone No.: (SIGNATURE OF DECLARANT) Facsimile No.: E-Mail Address: Mobile Tel. No.: DECLARATION FOR DEFAULT OR UNCONTESTED JUDGMENT
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