File No. STATE OF NORTH CAROLINA In The General Court Of Justice District Court Division County IN THE MATTER OF Name And Address AFFIDAVIT - NO LICENSE G.S. 20-16.5 County Of Residence State Of Residence NORTH CAROLINA RESIDENTS I, the undersigned, being first duly sworn, say that I am a resident of the county and state named above, and at the time of this charge: I am validly licensed to drive in North Carolina, but am unable to locate my license card. The circumstances of the loss and the efforts I have made to find the license card are: my license was expired. my license was revoked. I have never had a license. other: I was not currently licensed to drive in the State of North Carolina because OUT-OF-STATE RESIDENTS I, the undersigned, being first duly sworn, say that I am a resident of the county and state named above, and at the time of this charge: I was not currently licensed to drive in the State of North Carolina and did not have a valid drivers license from another state because my license was revoked. my license was expired. I have never had a license. other: I am validly licensed to drive by the State of , but am unable to locate my card. The circumstances of the loss and the efforts I have made to find the license card are: Signature Of Affiant SWORN AND SUBSCRIBED TO BEFORE ME Date Signature Deputy CSC Assistant CSC Magistrate Clerk Of Superior Court AOC-CVR-8, Rev. 11/97 1997 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkflow.com