COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : STATE OF NORTH CAROLINA COUNTY OF CUMBERLAND : CVS form Calendar No. IN THE GENERAL COURT OF JUSTICE : JUDICIAL SUBPOENA Ë SUPERIOR ËDISTRICT COURT DIVISION Plaintiff(s) -against- Name Plaintiff Index No. File No. : MOTION TO DISPENSE WITH : Ë Mediated Settlement Conference : Ë Court Ordered Arbitration vs. Name Defendant Defendant(s) : ...................................................... Cumberland County ADR Rule 5 NOTICE TO THE TRIAL COURT ADMINISTRATOR The undersigned party request this case be exempt from the following: THE PEOPLE OF THE STATE OF NEW YORK Ë (Superior Court) Mediated Settlement Conference Ë (District Court) Court Ordered Arbitration Trial Date This request is based upon the following reason(s): TO NOTE: Indicate with particularity the reason for request. GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed Ë All opposing counsel/party(ies) consent to the motion or adjourned date, to testify and give evidence as a witness in this action on the part of the Date Name of Movant Address and Telephone Number Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Ë Attorney for subpoena Attorney for Defendant Ë Unrepresented Party the party on whose behalf thisPlaintiff Ëwas issued for a maximum penalty of $50 and all damages sustained as a Indicate method of service to opposing parties Copy ofresult of your failure toto: (Provide Name and Address of all parties) this Notice distributed comply. Ë US Mail Court in Witness, Honorable County, Ë Facsimile ËHand Delivery , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for NOTICE: All counsel/ parties have a continuing obligation to notify this office of any correction/addition/deletion of counsel. Objection(s) received PART B [For Official Use Only] Ë no Ë yes (attach written objections) '2 127 :5,7( ,1 7+,6 63$&( Date Motion Received: Ruling Ë Denied Date CCLF-CV-005 Office and ËGranted P.O. Address Trial Court Administrator Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com