NORTH CAROLINA CUMBERLAND COUNTY _________________________________, Plaintiff vs. _________________________________, Defendant ) ) ) ) ) ) ) IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION FILE NUMBER: Servicemembers Waiver of Relief under S.C.R.A. 50 U.S.C. Ch. 50 §§3901-4043 OATH I, _________________________________, being duly sworn, depose and say: 1. I am an active duty member of our United States Armed Forces pursuant to 10 U.S.C. 101(d)(1) or member of a Reserve Unit or National Guard Unit that has been called to active duty for over thirty (30) days pursuant to 32 U.S.C. 502(f) and 50 U.S.C. Ch. 50 §3917. 2. I understand that the Servicemembers Civil Relief Act may entitle me to a stay of ninety (90) days or more when I make no appearance due to military deployment or absence from duty due to sickness, wounds, leave or other lawful cause. 3. I understand I have the right to request a stay in the proceedings and waive that right and ask that the case go forward without my appearance. 50 U.S.C. Ch. 50 §3932. 4. I have chosen not to pursue my rights under the S.C.R.A. I understand I am free to consult with a lawyer or J.A.G. regarding any rights that may be affected by law. 5. I understand that any request for a stay does not amount to an appearance for jurisdictional purposes or a waiver of any substantive or procedural defense. 50 U.S.C. Ch. 50 §3932 (c). Date:___________________ Signature:_____________________________________ Printed signature:_______________________________ NORTH CAROLINA CUMBERLAND COUNTY I, ____________________________________, a Notary Public in and for the aforesaid County and State, do hereby certify that ___________________________________ personally appeared before me this day and acknowledged the due execution of the foregoing instrument. This ______ day of ____________________, 20___. _______________________________________ Notary Public My Commission Expires:_______________ CCLF-CV-14 Rev. Dec. 15, 2015 American LegalNet, Inc. www.FormsWorkFlow.com