SUBPOENA(If issued pursuant to

Neb. Rev. Stat. § 25-1223(5))

Case No.

Plaintiff vs.

Defendant

SUBPOENAIf issued pursuant to Neb. Rev. Stat. § 25-1223(5).

At the request of an agency of state government or by a party permitted to proceed in forma pauperis.

( ) Duces Tecum

You are commanded to notify the following person(s): __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ to appear before this court on ___________________________, at _____ ___.m., to testify as witness(es) in the above-entitled case on behalf of __________________________________________.

Mail Service

You, ___________________________________________, are ordered to appear before this court on ___________________________, at _____ ___.m., to testify as witness(es) in the above-entitled case on behalf of __________________________________________.

and to bring the following:

As a witness in ________________________________________court, you are entitled to receive a witness fee in the amount of $________ for each day that you are required to be in court and, if you live more than one mile from the courthouse or place where the court is held, you are also entitled to receive mileage at the rate that state employees receive. Ask the lawyer or party who subpoenaed you or the clerk of the court for information about what you should do to receive the fees and mileage to which you are entitled.

Page 1 of 2 Subpoena CC 6:2.1 Rev. 05/19

Nebraska State Court Form

CC 6:2.1 Rev. 05/19Neb. Ct. R. §§ 6-330 and 6-334(A); Neb. Rev. Stat. § 25-1223(5)

DATE: BY THE COURT: (Seal) (Judge/Magistrate/Officer of the Court*)

*Officer of the Court only: complete the following information:

Name Street Address/P.O. Box

Bar Number and Firm Name (attorneys only) City/State/ZIP Code

Phone Email Address

Service by: Sheriff Constable Other (pursuant to Neb. Rev. Stat. § 25-1223(8))

TO: ____________________________of ________________ COUNTY, NEBRASKA:

RETURN

Received this Writ on I hereby certify that on

, at .m. , I served this Subpoena on

by

a true and certified copy thereof with all the endorsements thereon, in the county aforesaid.

Service: $ Mileage: miles $ Copy: $ Other $

TOTAL $

Date: Signature:

CERTIFICATE OF SERVICE

I certify that on , I served a copy of the foregoing upon the

Date: Signature:

following persons at the addresses given, by mailing by United States Mail, postage prepaid:

Name: Address:

Page 2 of 2 Subpoena CC 6:2.1 Rev. 05/19