STATE OF NORTH CAROLINA County Name And Address Of Plaintiff 1 File No. In The General Court Of Justice District Court Division Name And Address Of Plaintiff 2 DOMESTIC CIVIL ACTION COVER SHEET INITIAL FILING SUBSEQUENT FILING Rule 5(b), Rules of Practice For Superior and District Courts VERSUS Name Of Defendant 1 Jury Demanded In Pleading? No Yes Name And Address Of Attorney Or Party, If Not Represented (complete for initial appearance or change of address) Summons Submitted Name Of Defendant 2 Yes No Telephone No. Cell Telephone No. NC Attorney Bar No. Attorney E-Mail Address Initial Appearance in Case Summons Submitted Counsel for Change of Address Yes No Only (List party(ies) represented) Name Of Firm FAX No. All Plaintiffs All Defendants TYPE OF PLEADING (check all that apply) CLAIMS FOR RELIEF FOR: (check all that apply) Amended Answer/Reply (AMND-Response) Amended Complaint (AMND) Answer/Reply (ANSW-Response) Complaint (COMP) Confession Of Judgment (CNFJ) Contemp (CNTP) Assess Motions Fee Continue (CNTN) Assess Motions Fee Compel (CMPL) Assess Motions Fee Counterclaim vs. (CTCL) Assess Counterclaim Costs Extend Time For An Answer (MEOT-Response) Assess Motion Fee Modification Of Alimony (MALI) Assess Motions Fee Modification Of Custody (MCUS) Assess Motions Fee Modification Of Support in non-IV-D cases (MSUP) Assess Motions Fee Modification Of Visitation (MVIS) Assess Motions Fee Rule 12 Motion In Lieu Of Answer (MDLA) Assess Motions Fee Santions (SANC) Assess Motions Fee Show Cause (SHOW) Assess Motions Fee Transfer (TRFR) Assess Motion Fee Vacate/Modify Judgment or Order (VCMD) Assess Motions Fee Other (OTHR): (Use codes from Motions Coversheet AOC-CV-752 or specify) Alimony (ALIM) Annulment (ANUL) Child Support (CSUP) Custody (CUST) Divorce (DIVR) Divorce From Bed And Board (DIVB) Domestic Violence (DOME) Equitable Distribution (EQUD) Medical Coverage (MEDC) Paternity (PATR) Possession Of Personal Property (POPP) Post Separation Support (PSSU) Reimbursement For Public Assistance (RPPA) Visitation (VIST) Other: (specify and list separately) Date Signature Of Attorney/Party NOTE: All filings in civil actions shall include as the first page of the filing a cover sheet summarizing the critical elements of the filing in a format prescribed by the Administrative Office of the Courts, and the Clerk of Superior Court shall require a party to refile a filing which does not include the required cover sheet. For subsequent filings in civil actions, the filing party must include a Domestic (AOC-CV-750) Motions (AOC-CV-752) or Court Action (AOC-CV-753) cover sheet. American LegalNet, Inc. www.FormsWorkFlow.com AOC-CV-750, Rev. 6/11 � 2011 Administrative Office of the Courts