File No. STATE OF NORTH CAROLINA Film No. County In The General Court Of Justice District Superior Court Division Name Of Plaintiff DELAYED SERVICE VERSUS OF Name Of Defendant COMPLAINT G.S. 1A-1, Rules 3 & 4TO: TO: Name And Address Of Defendant 1 Name And Address Of Defendant 2 You are being served with a copy of the complaint in this action, the delayed filing of which was ordered when the summons was issued. You must: 1. Serve a copy of your written answer to the complaint upon the plaintiff or the plaintiffs attorney within thirty (30) days after you have been served. You may serve your answer by delivering a copy to the plaintiff or the plaintiffs attorney or by mailing a copy to one of them at his/her last known address. 2. File the original of the written answer with the Clerk of Superior Court of 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. Name And Address Of Plaintiffs Attorney (If None, Address Of Plaintiff)Date Time AM PM Signature Deputy CSC Assistant CSC Clerk Of Superior Court AOC-CV-103, Rev. 3/98 Original File Copy-Each Defendant Copy-Attorney/Plaintiff 1998 Administrative Office of the (Over) >>>> 2 RETURN OF SERVICE I certify that this Document and a copy of the Complaint were received and served as follows: DEFENDANT 1Date Served Name Of Defendant By delivering to the defendant named above a copy of this Document and Complaint. By leaving a copy of this Document 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 a corporation, service was effected by delivering a copy of this Document and Complaint to the person named below. Name And Address Of Person With Whom Copies Left (if corporation, give title of person copies left with) Service Accepted By Defendant Date Accepted Signature Other Manner Of Service (specify) Defendant WAS NOT served for the following reason: DEFENDANT 2Date Served Name Of Defendant By delivering to the defendant named above a copy of this Document and Complaint. By leaving a copy of this Document 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 a corporation, service was effected by delivering a copy of this Document and Complaint to the person named below. Name And Address Of Person With Whom Copies Left (if corporation, give title of person copies left with) Service Accepted By Defendant Date Accepted Signature Other Manner Of Service (specify) Defendant WAS NOT served for the following reason: Service Fee Paid Date Received Name Of Sheriff$ Paid By Date Of Return County Deputy Sheriff Making Return AOC-CV-103, Side Two, Rev. 3/98 1998 Administrative Office of the