STATE OF NORTH CAROLINA County Name And Address File No. In The General Court Of Justice District Court Division IN THE MATTER OF REVOCATION ORDER WHEN PERSON NOT PRESENT FINDINGS FOR PROBABLE CAUSE G.S. 20-16.5 The undersigned judicial official finds probable cause to believe that: 1. A law enforcement officer had reasonable grounds to believe that the above-named person committed an offense subject to the implied-consent provisions of G.S. 20-16.2; 2. The above-named person has been charged with that offense as provided in G.S. 20-16.2(a); 3. Both the law enforcement officer and the chemical analyst(s) complied with the provisions of G.S. 20-16.2 and 20-139.1 in requiring the abovenamed person's submission to or procuring a chemical analysis; and 4. The above-named person: a. willfully refused to submit to a chemical analysis. b. had an alcohol concentration of 0.08 or more at any relevant time after the driving. c. had an alcohol concentration of 0.04 or more at any relevant time after the driving of a commercial motor vehicle. d. had any alcohol concentration at any relevant time after the driving, and at the time of the offense, was under 21 years of age. 5. The above-named person has one or more pending offenses in the following county(ies) for which the person's drivers license had been or is revoked under G.S. 20-16.5. It is ORDERED that the above-named person's drivers license or privilege to drive be revoked, and the above-named person is prohibited from operating a motor vehicle on the highways of North Carolina during the period of revocation; and the revocation remains in effect at least thirty (30) days from: 1. the date he/she surrenders his/her drivers license or privilege to drive to the court, or demonstrates that he/she is not currently licensed to drive, if he/she does so within five (5) working days of the effective date of this Order (the failure of the above-named person to act within five (5) working days will result in a longer revocation period as explained in the Notice below); or 2. (check this option if Finding No. 5 is checked) the date he/she surrenders his/her drivers license or privilege to drive to the court, or demonstrates that he/she is not currently licensed to drive, if he/she does so within five (5) working days of the effective date of this Order (the failure of the abovenamed person to act within five (5) working days will result in a longer revocation period as explained in the Notice below), and indefinitely until a final judgment, including appeals, has been entered for the current offense and for all pending offenses for which his/her drivers license or privilege to drive had been or is revoked under G.S. 20-16.5. The above-named person's privilege to drive in North Carolina is revoked and will remain revoked until the person has actually surrendered his/her license for the period specified above and has paid a $100 fee to the Clerk of Superior Court. I am informing the above-named person of his/her right to a hearing by explaining this right in the Notice below. I am delivering a copy of this Order to him/her by depositing it in the United States mail as provided in G.S. 20-16.5(f). ORDER NOTE: The effective date specified herein is four (4) days after the Order is mailed. Count the four (4) days beginning with the day following the day of mailing pursuant to G.S. 1A-1, Rule 6. See reverse for Supplemental Findings and Order, and for Disposition of License or Privilege. Date Signature Of Judicial Official EFFECTIVE DATE OF ORDER: 12:01 a.m., , Deputy CSC Assistant CSC Clerk Of Superior Court Your license to drive is revoked as of the effective date shown above. If within five (5) working days of the effective date of this Order you surrender your drivers license to the Clerk of Superior Court or show you are not licensed to operate a motor vehicle, this Revocation remains in effect for at least a thirty (30) day period beginning on the date you surrender your license or make the showing. If you fail to do so, this Revocation remains in effect for at least a forty-five (45) day period beginning on the date you surrender your license or make the showing. Appearance before the Clerk of Superior Court must be made between 8:30 a.m. and 5:00 p.m., Monday through Friday. Your failure to appear before the Clerk of Superior Court may result in a law enforcement officer seizing your license or requiring you to demonstrate you are not licensed. In this event, this Revocation remains in effect for at least a forty-five (45) day period which will not begin until the officer seizes your license or you demonstrate you are not licensed. If at time of this Order you have only a temporary driving certificate, you must surrender the certificate, and then you also must surrender your license card immediately when you later receive it in the mail from DMV. If your license is revoked under Paragraph 1 of this Order, at the end of the revocation period you are still prohibited from driving until you have paid a fee of $100 to the Clerk of Superior Court. If your license is revoked under Paragraph 2 of this Order, this Revocation remains in effect for at least the thirty (30) or forty-five (45) days explained above and until a final judgment, including appeals, is entered for this current offense and for all pending offenses for which your license has been or is revoked under G.S. 20-16.5. At the end of the revocation period you are still prohibited from driving until you have paid a fee of $100 to the Clerk of Superior Court. This fee is in addition to any fee you have paid or are to pay in connection with any other pending offense for which your drivers license has been revoked under G.S. 20-16.5. The $100 fee may be paid at any time, even prior to the end of the period of revocation, between the hours of 8:30 a.m. and 5:00 p.m., Monday through Friday. Payment in person must be made in cash or by certified check, cashier's check or money order. Payment by mail must be made by certified check, cashier's check or money order, payable to the Clerk of Superior Court. If you wish to have your drivers license returned to you by mail, please enclose a stamped, self-addressed envelope with your payment. If prior to the effective date of this Order you were not licensed by the North Carolina Division of Motor Vehicles or did not have a valid license from another state, an additional $50 restoration fee must be paid to the Division of Motor Vehicles before you c