NORTH CAROLINA COUNTY OF WAKE IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION FILE NO. ____________________________ Assigned Judge:_______________________ ___________________________________, Plaintiff, v. REQUEST FOR REASSIGNMENT ___________________________________, Defendant. 1. That this matter is currently assigned to Judge ________________________________________. 2. For good cause, the undersigned hereby requests that a new judge be assigned to this matter as follows: ______________________________________________________________________ _____________________________________________________________________________ ____________________________________________________________________________ _____________________________________________________________________________ ____________________________________________________________________________ _____________________________________________________________________________ ____________________________________________________________________________ _____________________________________________________________________________ ____________________________________________________________________________ 3. That this Request is not being filed for improper purpose or delay. This the _______ day of __________________________, 20_____. __________________________________________________ Plaintiff Defendant Attorney for Plaintiff Attorney for Defendant WAKE-DOM-03A Page 1 of 2 (Rev. 02/10) American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF SERVICE I hereby certify that a copy of this Request for Reassignment has been served on the opposing party/counsel in the following manner: By depositing a copy in the US Mail in a properly addressed, postpaid envelope to: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ By hand delivery to: ___________________________________________________________ ____________________________________________________________________________ By facsimile to: _____________________________ Fax No.: _______________________ Other: ______________________________________________________________________ ____________________________________________________________________________ Date: _____________ __________________________________________________ Plaintiff Defendant Attorney for Plaintiff Attorney for Defendant WAKE-DOM-03A Page 2 of 2 (Rev. 02/10) American LegalNet, Inc. www.FormsWorkFlow.com