COURT COUNTY .OF. . . . .CAROLINA . . . . . . . . . . . . . . . . . . . . . . . . STATE. .OF .NORTH . . . . . . . . . . . . . . ... .. .. : County File No. Index No. In The General Court Of Justice District Superior Court Division : Calendar No. : PETITION FOR JUDICIAL SUBPOENA IN THE MATTER OF: Name And Address Of Applicant Plaintiff(s) LIMITED DRIVING PRIVILEGE PRETRIAL REVOCATION -againstRace Sex Height Hair Color Eye Color : : (IMPLIED-CONSENT OFFENSE) Date Of Birth Weight G.S. 20-16.5 Drivers License : No. State Defendant(s)Of Revocation If Different From Offense Date Date : ...................................................... Date Of Offense I, the undersigned applicant, request the Court to issue a limited driving privilege to me pursuant to G.S. 20-16.5(p). I certify that: 1. My license was revoked by the District Court Division of the General Court of Justice in the county shown above. THE PEOPLE OF THE STATE OF NEW YORK 2. I meet all of the eligibility requirements for a limited driving privilege under G.S. 20-16.5(p). (NOTE: See reverse side for eligibility requirements.) TO 3. I have attached a copy of the revocation order issued in this case. 4. I have attached the required documentation of my need to engage in employment-related driving at times other than 6:00 A.M. to 8:00 P.M. on Monday through Friday. 5. (Check if license revoked indefinitely.) I need a limited driving privilege to overcome undue hardship. GREETINGS: NOTE TO APPLICANT: You may attach any documentation to support your allegation of undue hardship. You may be required to provide WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court Signature Of Applicant located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed NOTICE OF HEARING or adjourned date, to testify and give evidence as a witness in this action on the part of the additional documentation, which may include a copy of your driving record and/or evidence of financial responsibility (insurance). Date Notice To The District Attorney: The applicant named above will apply to the district court judge presiding at the date, time and place of hearing shown below for issuance of a limited driving privilege. subpoena is punishable as a contempt of court and will make you liable to Your failure to comply with this Date Of Hearing the Time this subpoena was issued for a maximum penalty of $50 and all damages sustained as a AM Date party on whose behalf Of Hearing PM result of your failure to comply. Place Of Hearing Court in Signature Witness, Honorable County, , one of the Justices of the day of , 20Deputy CSC Assistant CSC Clerk Of Superior Court CERTIFICATION I certify that on this date, I filed a copy of this Petition with the district attorney's office in person. (Attorney must sign above and type name below) by depositing same in the U. S. mail in an envelope bearing proper postage. . Other: Date Signature Attorney(s) for Deputy CSC Assistant CSC Clerk Of Superior Court WAIVER I, the undersigned Prosecutor, waive the statutory requirement of the Clerk to file a copy of this Petition with the District Attorney's office and further waive the right to appear at a hearing on this PetitionP.O.limited driving privilege. Office and for Address Date Name Of Prosecutor (Type Or Print) Signature Of Prosecutor Telephone No.: Facsimile No.: office and sign the certification, unless the Prosecutor waives the right to having this Petition filed with his/her office. E-Mail Address: Mobile Tel. No.: AOC-CVR-9, Rev. 2/06 (Over) NOTE: The Clerk of Superior Court upon the filing of this Petition with a notice of hearing, should immediately file a copy with the District Attorney's © 2006 Administrative Office of the Courts American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. pursuant .to.G.S.. 20-16.5(p). are . . .follows: . . . . . . Eligibility .requirements . . . . . . . . . . . . . . . . . . . . . . as . . . . . . . ....... .. : If drivers license was revoked for a thirty (30) or forty-five (45) day period: : Index No. Calendar No. 1. At the time of the alleged offense the defendant held either a valid drivers license or a license that had been expired for less than one year; : JUDICIAL SUBPOENA Plaintiff(s) 2. The defendant does not have an unresolved pending charge involving impaired driving except the charge for which the -against: license is currently revoked or additional convictions of an offense involving impaired driving since being charged for the violation for which the license is currently revoked under 20-16.5; : 3. The defendant's license has been revoked for at least ten (10) days if: the revocation is for thirty (30) days or thirty (30) days if the revocation is for forty-five (45) days; and Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . assessment . . . . . 4. The defendant. has .obtained. a .substance .abuse . . . . . . . . . . .from. a . mental health facility and registered for and agreed to participate in any recommended training or treatment program. THE PEOPLE OF THE STATE OF If drivers license was revoked indefinitely: NEW YORK 1. At the time of the alleged offense the defendant held either a valid drivers license or a license that had been expired for TO less than one year; 2. At the time of the alleged offense the defendant had not within the preceding seven (7) years been convicted of an offense involving impaired driving; GREETINGS: 3. Subsequent to theCOMMAND YOU, that all business not been convictedlaid or hadyou unresolved charge lodged WE alleged offense, the defendant has and excuses being of, aside, an and each of you attend before against him/her for, an offense involving impaired driving;the , the Honorable at Court County of located at 4. The defendant must have completedday of (i) thirty (30) days ,of the period of license revocation for the any recessed either: in room , on the , 20 at o'clock in the noon, and at current offense if the defendant was present when the license was revoked or if the defendant was not present but surrendered his/her or adjourned date, to testify and give evidence as a witness in this action on the part of the license within five (5) working days after the effective date of the revocation order, or (ii) forty-five (45) days of the period of license revocation for the current offense if the defendant was not present when the license was revoked and did not surrender his/her license within five (5) working days of the effective date of the revocation order. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 5. The defendant has obtained and filed with the court a substance abuse assessment conducted damages sustained as a the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all by one of the entities authorizedof your Department of Health and Human Services to conduct assessments; and result by the failure to comply. 6. A limited driving privilege is necessary to overcome undue hardship. Court in Witness, Honorable County, day of , one of the Justices of the , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address AOC-CVR-9, Side Two, Rev. 2/06 © 2006 Administrative Office of the Courts Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com