DUR-DOM-01 (Rev. 8/17) Page 1 of 2 NORTH CAROLINA COUNTY OF DURHAM IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION FILE NO. CVD Assigned Judge: , Plaintiff, v. , Defendant. AFFIDAVIT FOR JUDICIAL ASSIGNMENT AND NOTICE OF HEARING The undersigned certifies the following: 1. That I am the Plaintiff/Plaintiff222s attorney Defendant/Defendant222s attorney in this matter. 2. That the attached Complaint Answer/Counterclaim Other: is: A newly filed action/matter. A filing in a pending (open) action involving the same parties or family in this District. A filing in a resolved (closed) action involving the same parties or family in this District. A filing in which there is a pending or resolved action involving the same parties or family in other districts in North Carolina or another state. A re-filing of an action with the same legal issues that were previously closed by voluntary dismissal, involuntary dismissal or discontinuance. 3. Durham County District Court Judge is or was the assigned judge in a pending or prior civil action in this District involving the same parties and/or family members (including either parties222 children) and/or related family issues. 4. An interpreter is needed to be present for court proceedings. YES NO If yes, what language(s) does the party speak? This the day of , 20. Signature of Plaintiff Defendant Attorney for Plaintiff Attorney for Defendant Print Name: Daytime Telephone Number Email Address: American LegalNet, Inc. www.FormsWorkFlow.com DUR-DOM-01 (Rev. 8/17) Page 2 of 2 PLEASE TAKE NOTICE THAT a hearing has been scheduled in this matter on the date and time indicated below, or as soon thereafter as the Court can hear this matter, in the courtroom indicated. FAMILY COURT COMPLETES THIS BOX Judge Assigned: Wilks Evans Maris Other: Temporary Hearing for: Temp. Custody Temp. Child Support Post Separation Support Interim Distribution Date: Time: Courtroom: Ex-Parte Hearing for Date: Time: Courtroom: Custody Mediation Orientation Date: Time: 9th floor conference room (9100) Status Conference (ED or Alimony) Date: Time: 6th floor Family Court Office (6500) Other: Date: Time: Courtroom: FC Staff: Date: Family Court Staff Use ONLY DIVR INCORP CUST CSUP EQUD ALIM DBB ATFE RESU QDRO TCUST TCSUP INDS PSSU TRO OTHER CERTIFICATE OF SERVICE I hereby certify that a copy of this Affidavit for Judicial Assignment and Notice of Hearing 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 Sheriff service to: By hand delivery to: By facsimile to: Fax No.: Other: Date: Plaintiff Defendant Attorney for Plaintiff Attorney for Defendant American LegalNet, Inc. www.FormsWorkFlow.com