COURT

COUNTY OF
......................................................
[ ] 17th Judicial Circuit in and for Broward County Florida : CLOCK IN
Index No.
[ ] In the County in and for Broward County
: Calendar No.
DIVISION: AFFIDAVIT OF IDENTITY
[ ] Criminal
[ ] Traffic AND WRITTEN PLEA OF NOT GUILTY
:
Plaintiff(s) JUDICIAL SUBPOENA
[ ] Other
-against- :
THE STATE OF FLORIDA VS. CASE NUMBER/
: CITATION NUMBER
PLAINTIFF DEFENDANT
:
AFFIANT’S NAME: Defendant(s) : SEX:
......................................................
ADDRESS:

HOME TELEPHONE: SOCIAL SECURITY # :

THE PEOPLE OF THE STATE OF NEW YORK
DATE OF BIRTH: RACE: HEIGHT:
TO
DRIVER LICENSE # : STATE:

PLACE OF EMPLOYMENT:
GREETINGS:
VEHICLES DRIVEN BY YOU:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
STATEMENT: I DENY EVER HAVING RECEIVED THIS CITATION
the Honorable at the BECAUSE:Court ,
EXPLAIN WHY YOU
County of COULD NOT HAVE BEEN locatedCITED
at FOR THIS VIOLATION, AND YOUR WHERE-ABOUTS AT THE
TIME THE CITATION WAS, ISSUED
in room on the ON Aday SEPARATE
of SHEET OF PAPER
, 20 , at AND ATTACH
o'clock inWITH
the ALLnoon,
OTHER
and at any recessed
SUBSTANTIATING DOCUMENTS, OR ATTACH A NOTARIZED AFFIDAVIT/LETTER FROM YOUR
or adjourned date, to testify and give evidence as a witness in this action on the part of the EMPLOYER, IF
YOU WERE AT WORK ON THE DATE AND TIME IN QUESTION.

DO YOU KNOW WHO IS USING YOUR NAME? [ ] YES [ ] NO

Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
HOW DO YOU KNOW THIS PERSON USED YOUR NAME?
the YES,
(IF partyGIVE
on whose behalf this subpoena
ANY INFORMATION THATwas
MAYissued for a maximum
BE HELPFUL TO THEpenalty
COURTofIN$50 and all damages
DETERMINING THEsustained as a
PERSONresult of your failure to comply.
INVOLVED WITH THIS CITATION.)

NAME: Witness, Honorable DATE OF BIRTH:

, one of the Justices of the
Court in
ADDRESS:
County, day of , 20

HOME TELEPHONE:
(Attorney must sign above and type name below)
PLACE OF EMPLOYMENT:

EMPLOYER’S ADDRESS:
Attorney(s) for
DID YOU FILE A POLICE REPORT OF STOLEN PROPERTY, WALLET, PURSE, DRIVER LICENSE, ETC?
[ ] YES [ ] NO (IF YES, ATTACH A COPY OF THE REPORT)

SWORN TO AND SUBSCRIBED BEFORE ME

THIS _________________
Office and P.O. Address DAY OF
AFFIANT’S SIGNATURE ________________________, 20______

Telephone No.:
DEPUTY CLERK FacsimileNOTARY
No.: PUBLIC
E-Mail Address:
FORM.621 SEARCH FEE: 698 Mobile Tel. No.: COPY FEE: 699

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