NORTH CAROLINA COUNTY OF WAKE IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION FILE NO. _________________________ Assigned Judge: _____________________ ___________________________________, Plaintiff ORDER SUBMISSION v. ___________________________________, Defendant 1. The attached order: [ ] was announced in open court. [ ] was announced to the attorneys of record. [ ] is entered pursuant to a Memorandum of Judgment/Order. [ ] is entered with the consent of both parties. Date order announced or Memorandum/consent order signed: _____________________ . 2. Check the box that applies: [ ] The opposing party/counsel has reviewed the order and all corrections/revisions have been resolved. Both parties agree that this order is correct as to form and is ready for entry of order. [ ] The draft was delivered to the opposing party/counsel by [ ] U.S. Mail [ ] Facsimile [ ] e-mail [ ] personal delivery on ___________________ . The opposing party/counsel has not responded to the order as drafted and more than ten (10) days have passed since the delivery of the draft. [ ] The opposing party/counsel has reviewed the order and does not believe that it is correct as to form. [ ] The written objections of each party are attached, or [ ] a diskette containing the order is attached. This the _____ day of ________________, 20___. _________________________________________ [ ] Plaintiff [ ] Defendant [ ] Plaintiff’s Attorney [ ] Defendant’s Attorney Name: ________________________________________ Address _______________________________________ ______________________________________________ Telephone Number: ____________________________ WAKE-DOM-22 (Rev. 2/06) American LegalNet, Inc. www.USCourtForms.com