COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
... ..
. . . . . . APPLICANT'S INFORMATION TO BE KEPT CONFIDENTIAL
: MC-410
Index No.
APPLICANT (name): FOR COURT USE ONLY
APPLICANT is Witness Juror Attorney Party : Other
Calendar
(Specify)
No.
Person submitting request (name):
APPLICANT'S ADDRESS: :
Plaintiff(s) JUDICIAL SUBPOENA
TELEPHONE NO.: -against- :
NAME OF COURT:
STREET ADDRESS: :
MAILING ADDRESS:
CITY AND ZIP CODE: :
BRANCH NAME:
Defendant(s) :
.....
. . . . . . . . . . JUDGE:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DEPARTMENT:
CASE TITLE
: CASE NUMBER:
REQUEST FOR ACCOMMODATIONS BY PERSONS
THE PEOPLE OF THE STATE OF NEW YORKAND RESPONSE
WITH DISABILITIES
Applicant requests accommodation under rule 1.100 of the California Rules of Court, as follows:
TO
1. Type of proceeding: Criminal Civil
2. Proceedings to be covered(for example, bail hearing, preliminary hearing, trial, sentencing hearing, family, probate, juvenile):
GREETINGS:
3. Date or dates needed (specify):
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Impairment necessitating accommodation (specify):
4. the Honorable at the Court ,
County of located at
5. in room , on the day of
Type or types of accommodation requested (specify): , 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
6. Special requests or anticipated problems (specify):
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
make you liable to
Your failure to comply with this subpoena is punishable as a contempt of court and will
Date:
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.
(TYPE OR PRINT NAME) (SIGNATURE)
Witness, Honorable RESPONSE , one of the Justices of the
The accommodation request is GRANTED and
Court in County, day of , 20
the court will provide the The accommodation is DENIED because it
requested accommodation, in whole fails to satisfy the requirements of rule 1.100
creates an undue burden on the court
requested accommodation, in part (specify below):
fundamentally alters name below)
(Attorney must sign above and type the nature of the service,
alternative accommodation (specify below): program, or activity
For the following reason (attach additional pages, if
necessary): [See Cal. Rules of Court, rule 1.100(g),
Attorney(s) for
for the review procedure.]
For the following duration:
For the above matter or appearance
From (dates): to
Indefinite period
Office and P.O. Address
Date:
Telephone No.:
(TYPE OR PRINT NAME) Facsimile No.: (SIGNATURE)
SIGNATURE FOLLOWS THE LAST PAGE OF THE RESPONSE.
E-Mail Address: Page 1 of 1
Form Approved for Optional Use Cal. Rules of Court, rule 1.100
Judicial Council of California REQUEST FOR ACCOMMODATIONS BY PERSONS
Mobile Tel. No.: www.courtinfo.ca.gov
MC-410 [Rev. January 1, 2007] WITH DISABILITIES AND RESPONSE
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