COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. APPLICANT'S INFORMATION TO BE KEPT CONFIDENTIAL : Index No.
APPLICANT (name): APPLICANT is Witness Juror Attorney Party
FOR COURT USE ONLY
MC-410
: : : : :
Person submitting request (name): APPLICANT'S ADDRESS:
Other Calendar (Specify)
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TELEPHONE NO.:
NAME OF COURT:
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:
Defendant(s) : . . . . . . . . . .JUDGE: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .....
CASE TITLE
DEPARTMENT: CASE NUMBER:
REQUEST FOR ACCOMMODATIONS BY PERSONS THE PEOPLE OF THE STATE OF NEW YORK WITH DISABILITIES AND RESPONSE
:
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): 3. Date or dates needed (specify):
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed 5. Type or types of accommodation requested (specify): or adjourned date, to testify and give evidence as a witness in this action on the part of the
4. Impairment necessitating accommodation (specify): the Honorable 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. Your failure to comply with this subpoena is punishable as a contempt of court and will Date:
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.
(TYPE OR PRINT NAME) (SIGNATURE)
Witness, Honorable
The accommodation request is GRANTED and Court in County, day of the court will provide the requested accommodation, in whole
RESPONSE
, one of the Justices of the
The accommodation is DENIED because it fails to satisfy the requirements of rule 1.100 creates an undue burden on the court (Attorney must sign above and type the nature of the service, fundamentally alters name 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.]
, 20
requested accommodation, in part (specify below): alternative accommodation (specify below):
For the following duration: For the above matter or appearance From (dates): Indefinite period Date: to
Office and P.O. Address
(TYPE OR PRINT NAME)
Form Approved for Optional Use Judicial Council of California MC-410 [Rev. January 1, 2007]
Telephone No.: (SIGNATURE) Facsimile No.: SIGNATURE FOLLOWS THE E-Mail Address: LAST PAGE OF THE RESPONSE. Page 1 of 1 Cal. Rules of Court, rule 1.100 Mobile Tel. No.: REQUEST FOR ACCOMMODATIONS BY PERSONS www.courtinfo.ca.gov
WITH DISABILITIES AND RESPONSE
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