File No. STATE OF NORTH CAROLINA In The General Court Of Justice District Superior Court Division County Name Of Plaintiff APPLICATION AND ORDER EXTENDING TIME TO FILE COMPLAINT VERSUS Name Of Defendant G.S. 1A-1, Rule 3 APPLICATION The undersigned requests permission to file a complaint in this action within twenty (20) days of any order granting this Application, as provided in Rule 3 of the Rules of Civil Procedure. The nature and purpose of the action are: Name And Purpose Of The Action Date Signature Applicant Attorney For Applicant ORDER The Court states that the nature and purpose of this action are as set forth above. Therefore, it is ORDERED that permission is granted to the applicant to file a complaint in this action up to and including the date shown below. File Complaint On Or Before (Date must be within 20 days of date of Order.) Date Of Order Signature Assistant Clerk Of Superior Court NOTE: Clerk Of Superior Court Under Rule 3 of the Rules of Civil Procedure, upon entry of this Order, a summons shall be issued and the summons and a copy of this Order must be served in accordance with the provisions of Rule 4. A complaint must be filed in this action within the period provided above and that complaint must be served in accordance with the provisions of Rule 4 or by registered mail if the plaintiff so elects. If a complaint is not filed within the above period, the action shall abate. AOC-CV-101, Rev. 7/11 © 2011 Administrative Office of the Courts (Over) American LegalNet, Inc. www.FormsWorkFlow.com File No. STATE OF NORTH CAROLINA In The General Court Of Justice District Superior Court Division County Name Of Complainant(s) MOTION AND ORDER EXTENDING STATUTE OF LIMITATIONS IN MEDICAL MALPRACTICE ACTION VERSUS Name Of Prospective Defendant(s) G.S. 1A-1, Rule 9(j) MOTION The complainant(s) named above intends to commence a medical malpractice action against the prospective defendant(s) named above on a cause of action that arose in the county named above, and, based on the facts listed below, needs additional time to comply with Rule 9(j) of the North Carolina Rules of Civil Procedure. The applicable statute of limitations has not yet expired. The complainant(s) moves to extend the statute of limitations for a period not to exceed one hundred twenty (120) days. (Specify basis for motion to enable judge to determine good cause exists.) Signature Date Complainant Attorney ORDER The undersigned Resident Superior Court Judge of the county named above has has not determined that good cause exists for granting the above motion and that the ends of justice will be served by an extension. The Court finds the facts listed in the motion and adopts those as a basis for determining good cause. It is ORDERED that: the motion is allowed and the statute of limitations applicable to the complainant(s) cause of action is extended to and including the date shown below. the motion is denied. Statute Of Limitations Extended To: Date Of Order Signature Of Resident Superior Court Judge Name Of Resident Superior Court Judge (Type Or Print) NOTE: Rule 9(j) of the Rules of Civil Procedure provides, "Upon motion by the complainant prior to the expiration of the applicable statute of limitations, a resident judge of the superior court for a judicial district in which venue for the cause of action is appropriate under G.S. 1-82 or, if no resident judge for that judicial district is physically present in that judicial district, otherwise available, or able or willing to consider the motion, then any presiding judge of the superior court for that judicial district may allow a motion to extend the statute of limitations for a period not to exceed 120 days to file a complaint in a medical malpractice action in order to comply with this Rule, upon a determination that good cause exists for the granting of the motion and that the ends of justice would be served by an extension." AOC-CV-101, Side Two, Rev. 7/11 © 2011 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com