File No(s) STATE OF NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION COUNTY OF _____________________ Attorney State Bar No. SECURED LEAVE NOTICE SECURED LEAVE Address NOTICE Telephone No Fax No. Rule 26, Rule 33A Rules of Appellate Procedure Notice: Secured Leave shall consist of one or more calendared weeks, but in any event shall not consist of more than three (3) consecutive weeks during any calendar year. STATEMENT OF ATTORNEY I hereby certify that the secured leave period designated below is not being designated for the purpose delaying, hindering or interfering with the timely disposition of any matter in any pending action or proceeding I further certify that no action or proceeding in which I have entered an appearance has been scheduled peremptorily set or noticed for trial, hearing, deposition or other proceeding during the designated leave period. DESIGNATED SECURED DATES Beginning Date: Ending Date: Indicate any previously designed Secured Leave periods during the current calendar year that have previously been designated pursuant to Rule 26 and Rule 33A of the Rules of Appellate Procedure. Beginning Date:: Ending Date: This Secured Leave notification must be filed not later than ninety (90) days before the beginning of the secured leave period and before any trial, hearing, deposition or other regularly scheduled matter, peremptorily set or noticed for a time during the designated leave period. Date: Attorney: The attorney of record must fax a filed copy of this form to District Attorney (if criminal), Chief District Court Judge (if in DC) and Opposing Counsel. CERTIFICATE OF SERVICE This is to certify that the undersigned has this date served this Notice upon the following persons by FAXING a filed copy to their business office. District Attorney Date: ___________________________________ Chief District Court Judge (919) 209-5490 Clerk Of Superior Court Signature: ___________________________________________________ NOTICE TO ATTORNEY: Should any matter be set during your Secured Leave Period, you are required to serve notice on the official calendaring the matter and the parties of record to the matter. This notice shall contain the following: (1) filed copy of this form, (2) case name and number and (3) certificate of service. DC Secured Leave Form District 11 District Court Effective 8/9/11 American LegalNet, Inc. www.FormsWorkFlow.com DC Secured Leave Form District 11 District Court Effective 8/9/11 American LegalNet, Inc. www.FormsWorkFlow.com