ELMIRA CITY COURT

317 E CHURCH STREET

ELMIRA, NY 14901

(607) 737 - 5829

SUBPOENA REQUEST FORM

ALL REQUESTS MUST BE APPROVED BY

THE JUDGE OR CHIEF CLERK

DATE: ____________________________________________

DOCKET # ________________________________________

TRIAL DATE: ______________________________________

DEFENDANT NAME: _______________________________

PERSON REQUESTING SUBPOENA___________________

WITNESS REASON WITNESS IS NEEDED NAME & ADDRESS

1. ____________________________ 1.______________________________________

______________________________ ______________________________________ _______________________________ ______________________________________

_______________________________ ______________________________________

2. ____________________________ 2.______________________________________

______________________________ ______________________________________ _______________________________ ______________________________________

_______________________________ ______________________________________

3_____________________________ 3.______________________________________

______________________________ ______________________________________ _______________________________ ______________________________________

_______________________________ ______________________________________

4. ____________________________ 4.______________________________________

______________________________ ______________________________________ _______________________________ ______________________________________

_______________________________ ______________________________________

5. ____________________________ 5.______________________________________

______________________________ ______________________________________ _______________________________ ______________________________________

_______________________________ ______________________________________

Granted: ______________

                                                                                      REQUESTED BY: _________________________

Denied: ______________

Date: ______________                                                                                  Revised 2/9/04