COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): :
TELEPHONE NO. (Optional): EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional):
FL-397
Index No. Calendar No.
FOR COURT USE ONLY
Plaintiff(s) -against-
: : : :
JUDICIAL SUBPOENA
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:
PETITIONER/PLAINTIFF:
Defendant(s) : ......................................................
RESPONDENT/DEFENDANT:
CASE NUMBER:
THE PEOPLEREQUEST FOR INCOME AND BENEFIT OF THE STATE OF NEW YORK
INFORMATION FROM EMPLOYER
TO
To (employer name): 1. This notice is served on you, under California Family Code section 3664(b), in regard to your employee (name): GREETINGS: 2. I previously served a request for an Income and Expense Declaration (form FL-150) after judgment on your employee and: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend a. There was no response within 35 days the Honorable at the Court or located at County ofresponse was incomplete as to wage information. b. The
before ,
in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned information sought begive evidenceor before (date): this action on the part of the , which is at least 15 days date, to testify and sent to me on as a witness in 3. I request that the
from the date of this request. 4. I request that you, as the employer of the above employee, provide the following information (indicated by checked boxes below). Your failure to comply with this subpoena is punishable as a contempt of court on a separate form. If you wish, you may return a copy of this form with the information filled out or provide the information 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 a. Occupation of employee: of your failure to comply. b. result(1) Presently employed: Yes No
(2) If employed, current employment status: Full time Part time (3) IfWitness, Honorable not presently employed: , one of the Justices of the (a) Date of separation: Court in County, day of , 20 (b) Reasons for separation: Starting date of employment: Gross salary or wages for the previous month (including commissions, bonuses, and overtime): Total salary or wages for the previous 12 months (including commissions, must sign aboveovertime): (Attorney bonuses, and and type name below) Federal income tax withheld for the previous month: State income tax withheld for the previous month: Social Security and Medicare Tax ("FICA" and "MEDI") deducted for the previous month: Attorney(s) for Any other deductions from the paycheck for the previous month (for each deduction state purpose and amount):
c. d. e. f. g. h. i.
Office and P.O. Address
Form Adopted for Mandatory Use Judicial Council of California FL-397 [Rev. January 1, 2003]
Telephone No.: Facsimile No.: E-Mail Address: REQUEST FOR INCOME AND BENEFIT Mobile Tel. INFORMATION FROM EMPLOYER No.:
Page 1 of 2 Family Code, § 3664 www.courtinfo.ca.gov
American LegalNet, Inc. www.USCourtForms.com
PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT:
CASE NUMBER:
j.
Benefits provided: (1) Vision insurance (2) (3) (4) (5) Life insurance Health insurance Contributions toward retirement plan
Not available Not available Not available Not available
Not enrolled Not enrolled Not enrolled Not enrolled
Enrolled (specify value to employee): Enrolled (specify value to employee): Enrolled (specify value to employee): Enrolled (specify asset value to employee):
k.
Use of company assets (vehicle, housing, health club facility, etc.) Not available Not enrolled Enrolled (specify value to employee): Attach a copy of the employee's three most recent pay stubs.
5. You are entitled to have me pay the reasonable costs of copying the information in this request. 6. Under Family Code section 3664(f), your compliance with this request is voluntary except upon order of the court or upon agreement of the parties, employers, and employee affected. Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF REQUESTING PARTY)
NOTICE TO EMPLOYEE
I have served a copy of the attached Request for Income and Benefit Information From Employer on your employer under Family Code section 3664(b). Under Family Code section 3664(c), you are notified that: 1. The information sought by me is limited to the income and benefits provided to you by your employer. 2. The information may be protected by right of privacy. 3. If you object to the production of this information by the employer to me, you must notify the court, in writing, of this objection prior to the date specified in paragraph 3 of the attached request. 4. If, upon your objection, I do not agree, in writing, to cancel or narrow the scope of my request, you should consult an attorney regarding your right to privacy and how to protect this right. 5. You may have other rights provided by Family Code section 3664 and otherwise.
NOTICE TO REQUESTING PARTY
Under Family Code section 3664(e), service of this request on the employer and of the copy of the request on the employee must be by certified mail, postage prepaid, return receipt requested, to the last known address of the party to be served, or by personal service.
FL-397 [Rev. January 1, 2003]
REQUEST FOR INCOME AND BENEFIT INFORMATION FROM EMPLOYER
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