ADA Request For Reasonable Accomodation

COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Plaintiff(s) -against: : : Index No. Calendar No. JUDICIAL SUBPOENA Name: Address: Phone: Comp. # (if applicable): THE PEOPLE OF THE STATE OF NEW YORK TO : Defendant(s) : ...................................................... City, State, Zip: ARIZONA SUPERIOR COURT, PIMA COUNTY Case Number: REQUEST FOR REASONABLE In the Matter of GREETINGS: WE COMMAND YOU, that all business andACCOMMODATION FOR DISABILITYattend before excuses being laid aside, you and each of you Date , the Honorable of Birth: at the Court located at County of in1. I, _____________________________,20 room , on the day of , request reasonable in the , at o'clock accommodation byany recessed noon, and at the Court or adjourned date, to testify and give evidence as a witness in this action on the part of the for my disability. 2. My relationship to this case is I am the: ________________________________________. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalfarose on or about _____ /a _____ / ____ and consistsall damages sustained as a 3. My disability first this subpoena was issued for maximum penalty of $50 and of: _____________ result ________________________________________________________________________ of your failure to comply. ________________________________________________________________________ Witness, Honorable , one of the Justices of the ________________________________________________________________________ Court in 4. I request the following form(s) of specific, reasonable, and necessary accommodation: ________________________________________________________________________ ________________________________________________________________________ (Attorney must sign above and type name below) ________________________________________________________________________ The undersigned swear or affirm that the statements set forth above are true and correct, subject Attorney(s) for to the penalties of making a false affidavit or declaration. Date: ___________________ ________________________________ Signature of Requesting Party Office and P.O. Address County, day of , 20 Copies mailed this date to: Assigned Division Mike Stafford, Court ADA Coordinator Parties 1 of 1 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com