25 CAR pt. 34, Appendix A. Office of Appeals and Hearings Subpoena Request Form

OFFICE OF APPEALS AND HEARINGS SUBPOENA REQUEST FORM IN THE MATTER OF: ~61~ (Case Number: ~48~) Note: Only witnesses who have testimony which is relevant (considered necessary and material) to the issues in your case will be allowed to testify on your behalf. The assigned hearing officer will determine the relevance of all testimony. The hearing officer has the discretion to exclude testimony or evidence which is not relevant, privileged, cumulative, confusing, a waste of time or which unduly delays the hearing. 1. The following witnesses will appear at the hearing on my behalf voluntarily. I will notify them of the date, time, and place of the hearing. Name: ________________________________________ Why witness is necessary: __________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Name: ________________________________________ Why witness is necessary: __________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Name: ________________________________________ Why witness is necessary: __________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ If you need additional space, please attach a separate sheet to this form with the information requested above. 2. I request that subpoenas be issued to these individuals. Note: A witness who is subpoenaed to testify on your behalf is entitled to a witness fee and mileage cost from the witness’ residence to the place of the hearing. It is the responsibility of the requesting party to pay the witness fee and mileage cost to each subpoenaed witness. A subpoena is enforceable only if it is duly served in accordance with state law. Name: ________________________________________ Address: ________________________________________ ________________________________________ ________________________________________ Telephone: ________________________________________ Why witness is necessary: __________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Name: ________________________________________ Address: ________________________________________ ________________________________________ ________________________________________ Telephone: ________________________________________ Why witness is necessary: __________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Name: ________________________________________ Address: ________________________________________ ________________________________________ ________________________________________ Telephone: ________________________________________ Why witness is necessary: ________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ If you need additional space, please attach a separate sheet to this form with the information requested above. IN THE MATTER OF: ~61~ (Case Number: ~48~) 3. Check here if you do not wish to subpoena any witnesses. ________ I do not wish to subpoena any witnesses. I hereby waive this right by my signature below. ________________________________ Signature of Appellant or Representative __________________________ Date