File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Court Division IN THE MATTER OF Name And Address REVOCATION REPORT TO DIVISION OF MOTOR VEHICLES CORRECTION SPECIAL G.S. 20-16.5 Race Sex DOB Drivers License No. State TO THE DIVISION OF MOTOR VEHICLES CORRECTION 1. The drivers license of the above named person was reported revoked under G.S. 20-16.5 on and the revocation was sent in error. 2. The drivers license of the above named person was revoked under G.S. 20-16.5 on and: a. The revocation was terminated on . b. on , a revocation compliance was sent to DMV in error. c. the fee was paid and the license returned to the licensee on . SPECIAL 1. The drivers license of the above named person is reported revoked under G.S. 20-16.5 on and the case is at superior court level. The revocation cannot be sent electronically. 2. The drivers license of the above named person was revoked under G.S. 20-16.5 on , and the fee was paid and the license was returned to the licensee on . The compliance cannot be sent electronically. Date Signature Deputy CSC Assistant CSC Clerk Of Superior Court AOC-CVR-7, Rev. 11/97 1997 Administrative Office of the Courts