COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : (TYPE OR PRINT IN BLACK INK) Index Court File No. No. STATE OF NORTH CAROLINA Calendar No. : County Plaintiff(s) Name Of Plaintiff (Or Mother) -against- : In The General Court Of Justice District Court Division JUDICIAL SUBPOENA : VERSUS : AFFIDAVIT OF PARENTAGE Name Of Defendant (Or Father) : Name And Address Of Father G.S. 110-132 Name And Address Of Mother Defendant(s) : ...................................................... Father's DOB Race Father's Social Security No. THE PEOPLE OF THE STATE OF NEW YORK Birthplace Of Father (County And State) Maiden Name Of Mother Mother's Social Security No. TO Name Of Child(ren) Date Of Birth Child(ren) Birthplace (County And State) Social Security No. GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed NOTICE in this action on the part of the or adjourned date, to testify and give evidence as a witness Signing this document may impose substantial legal obligations upon you. If you do not fully understand these obligations, you may consult a lawyer, at your own expense, before signing. Providing false or inaccurate information on this document may result in criminal penalties against you. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Unless rescinded,whose behalf this subpoena was issued forpaternity and penalty same legal effect as a judgment of as a the party on this document constitutes an admission of a maximum has the of $50 and all damages sustained paternity for the purpose of establishing your legal duty to support the above-named children. result of your failure to comply. This document may be rescinded by the child(ren)'s mother or the putative father (a) within sixty (60) days of the date this document is executed, or (b) before entry of an order establishing paternity or ,an orderthe Justices of the child Witness, Honorable one of for the payment of support, whichever is earlier. To rescind this document, you must file a request for rescission with the Clerk of Superior Court in County, day of , 20 Court and request a hearing before the district court within the time period indicated above. After sixty (60) days have elapsed, execution of this document may be challenged in court only upon the basis of fraud, duress, mistake, or excusable neglect. (Attorney FATHER'S ACKNOWLEDGMENTmust sign above and type name below) I, the undersigned, being duly sworn, freely and voluntarily declare and acknowledge that I am the natural father of the child(ren) named herein, and that the information regarding myself, the natural mother, and the minor child(ren) is true Attorney(s) for and correct to the best of my knowledge, information and belief. Date SWORN AND SUBSCRIBED TO BEFORE ME Date Signature Of Person Authorized To Administer Oaths Signature Of Natural Father Office and P.O. Address Deputy CSC Assistant CSC Clerk Of Superior Court Date My Commission Expires SEAL Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Notary AOC-CV-604, Rev. 7/01 2001 Administrative Office of the Courts (Over) American LegalNet, Inc. www.FormsWorkflow.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : MOTHER'S AFFIRMATION Index No. I, the undersigned, being duly sworn, declare and affirm that: : Calendar No. 1. I am the mother of the above-named child(ren); : JUDICIAL SUBPOENA Plaintiff(s) 2. the above-named father is the father of the above-named child(ren); and -against- : 3. the above information regarding myself, the father, and the minor child(ren) is true and correct to the best of my : knowledge, information, and belief. I also declare and affirm that I born. was not married was married: when the above-named child(ren) was/were Defendant(s) : . . you were married to . . . . . . . . . . . than . . . . . . . . . . . . . . . . the NOTE:. If . . . . . . . . . . . . . . . someone other . . . . the .above-named. father .at . . time you became pregnant or when the child(ren) was born, you must provide additional evidence (e.g., affidavit from your husband or court order) that your husband is not the child(ren)'s father. Date SWORN AND SUBSCRIBED TO BEFORE ME THE PEOPLE OF THE STATE OF NEW YORK Date Signature Of Person Authorized To Administer Oaths Signature Of Mother TO Deputy CSC Assistant CSC Clerk Of Superior Court Date My Commission Expires SEAL Notary GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address AOC-CV-604, Side Two, Rev. 07/01 2001 Administrative Office of the Courts Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.FormsWorkflow.com