STATE OF NORTH CAROLINA Harnett County File Number In The General Court Of Justice District Court Division Name of Plaintiff(s) VERSUS Name of Defendant(s) ORDER TO APPEAR AND SHOW CAUSE FOR FAILURE TO APPEAR AND COMPLY WITH CUSTODY MEDIATION TO PLAINTIFF DEFENDANT: The undersigned District Court Judge finds that there is probable cause to believe that you are in contempt of court for failing to appear for Custody Mediation on , 20 as Ordered by this court. YOU ARE HEREBY ORDERED TO APPEAR on Lillington, Harnett County, North Carolina. , 20 , at AM PM in If you are found to be in civil contempt, you may be committed to Jail for as long as such civil contempt continues. If you are found to be in criminal contempt, you may be fined up to $500, imprisoned for up to 30 days, or both. FAILURE TO APPEAR WILL BE GROUNDS FOR CONTEMPT AND YOUR IMMEDIATE ARREST MAY BE ORDERED. Date: __________________________________________ District Court Judge RETURN OF SERVICE ON BACK Dom-8 (rev. 10/2014) District 11 ­ Custody Mediation Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com RETURN OF SERVICE I certify that this ORDER TO APPEAR AND SHOW CAUSE was received and served as follows: By delivering to the person named below a copy of the Order to Appear and Show Cause. By leaving a copy of the Order to Appear and Show Cause at the dwelling house or usual place of abode of the person named below with a person of suitable age and discretion then residing therein. Name and address of person with whom copies left with: Other manner of service: Party was not served for the following reason: Service fee paid $ Signature of Deputy Sheriff making Return Date Received Name of Sheriff (Type or Print) Date of Return County of Sheriff Dom-8 (rev. 10/2014) District 11 ­ Custody Mediation Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com