This document is a subpoena issued by an Administrative Law Judge in Georgia. It commands an individual named to appear at a hearing on a given date and time regarding a case between a petitioner and respondent. It provides instructions for serving the subpoena either in person or via certified mail. It notes that failure to comply could result in penalties under Georgia law and provides contact information for questions about the subpoena.

1. STATE OF GEORGIA
COUNTY
I have this day served personally with a copy of the within subpoena;
This day of , 20 .
STATE OF GEORGIA
COUNTY
I have this day served with a copy of the within subpoena by
mailing a copy of same by certified mail to:
This day of , 20 .
CW_534 Subpoena (Rev. 09/06) Page 1 on 2

2. Department of Human Resources
OFFICE OF STATE ADMINISTRATIVE HEARINGS
STATE OF GEORGIA
Petitioner DOCKET NUMBER
v.
Respondent
SUBPOENA
TO:
You are hereby commanded to appear at a hearing in the above matter, at
on ,
20 ,at a.m./ p.m., and to remain in attendance for day to day thereafter until
Discharged by the undersigned Administrative Law Judge to testify on behalf of .
This subpoena is issued under authority of § 50-13-13 of the Official Code of Georgia.
HEREIN FAIL NOT UNDER PENALTY OF LAW.
Issued this Day of , 20 .
Administrative Law Judge
Questions regarding this subpoena should be directed to:
Telephone:
CW_534 Subpoena (Rev. 09/06) Page 2 on 2