File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Court DivisionName And Address Of Plaintiff CIVIL SUMMONS IN ACTION BY UNDERAGE PERSON VERSUS Name And Address Of Plaintiffs Father-Defendant 1 FOR AUTHORIZATION TO MARRY ALIAS AND PLUMES SUMMONS G.S. 1A-1, RULE 4Name And Address Of Plaintiffs Mother-Defendant 2 Date Original Summons Issued Name And Address Of Plaintiffs Legal Guardian Or Custodian-Defendant 3Date(s) Subsequent Summons(es) Issued The Plaintiff named above, a minor, has filed a civil action seeking authorization to marry. You are notified to appear and answer the complaint of the plaintiff as follows: 1. Serve a copy of your written answer to the complaint upon the plaintiff or plaintiffs guardian ad litem, named on the attached complaint, within thirty (30) days after you are served with this summons. You may serve your answer by delivering a copy to the plaintiff, by mailing it to the plaintiffs last known address, or by mailing it to the guardian ad litem named on the complaint. 2. File the original of your answer with the Clerk of Superior Court in the county named above. If you fail to answer the complaint, the plaintiff will apply to the Court for the relief demanded in the complaint. Date Issued Time Signature AM PM ENDORSEMENT Deputy CSC Assistant CSC Clerk Of Superior Court This Summons was originally issued on the date indicated above and returned not served. At the request of the plaintiff, the time within which this Summons must be served is extended sixty (60) days. AOC-CV-121, New 10/01 Over 2001 Administrative Office of the Courts American LegalNet, Inc. www.USCourtForms.com>>>> 2 RETURN OF SERVICE I certify that this Summons and a copy of the complaint were received and served as follows: PLAINTIFFS FATHER - DEFENDANT 1 Date Served Time Served Name Of Defendant AM PM By delivering to the defendant named above a copy of the summons and complaint. By leaving a copy of the summons and complaint at the dwelling house or usual place of abode of the defendant named above with a person of suitable age and discretion then residing therein. Name And Address Of Person With Whom Copies Left Defendant WAS NOT served for the following reason: PLAINTIFFS MOTHER - DEFENDANT 2 Date Served Time Served Name Of Defendant AM PM By delivering to the defendant named above a copy of the summons and complaint. By leaving a copy of the summons and complaint at the dwelling house or usual place of abode of the defendant named above with a person of suitable age and discretion then residing therein. Name And Address Of Person With Whom Copies Left Defendant WAS NOT served for the following reason: PLAINTIFFS LEGAL GUARDIAN OR CUSTODIAN - DEFENDANT 3 Date Served Time Served Name Of Defendant AM PM By delivering to the defendant named above a copy of the summons and complaint. By leaving a copy of the summons and complaint at the dwelling house or usual place of abode of the defendant named above with a person of suitable age and discretion then residing therein. As the defendant is the County Department of Social Services, service was effected by delivering a copy of the summons and complaint to the Director of that Department named below. Name Of Person With Whom Copies Left Other: Defendant WAS NOT served for the following reason: Service Fee Paid Signature Of Deputy Sheriff Making Return $ Date Received Name Of Sheriff (Type Or Print) Date Of Return County Of Sheriff AOC-CV-121, Side Two, New 10/01 2001 Administrative Office of the Courts American LegalNet, Inc. www.USCourtForms.com