STATE OF NORTH CAROLINA County Name And Address Of Plaintiff 1 File No. In The General Court Of Justice District Superior Court Division GENERAL INITIAL FILING CIVIL ACTION COVER SHEET Name And Address Of Plaintiff 2 SUBSEQUENT FILING Rule 5(b), General Rules of Practice For Superior and District Courts Name And Address Of Attorney Or Party, If Not Represented (complete for initial appearance or change of address) Name Of Defendant 1 VERSUS Telephone No. NC Attorney Bar No. Cellular Telephone No. Attorney E-Mail Address Summons Submitted Name Of Defendant 2 Yes No Initial Appearance in Case Name Of Firm FAX No. Counsel for Change of Address Summons Submitted All Plaintiffs Yes No All Defendants Only (list party(ies) represented) Jury Demanded In Pleading Complex Litigation Amount in controversy does not exceed $15,000 Stipulate to arbitration TYPE OF PLEADING (check all that apply) (check all that apply) Amend (AMND) Amended Answer/Reply (AMND-Response) Amended Complaint (AMND) Assess Costs (COST) Answer/Reply (ANSW-Response) (see Note) Change Venue (CHVN) Complaint (COMP) Confession Of Judgment (CNJF) Consent Order (CONS) Consolidate (CNSL) Contempt (CNTP) Continue (CNTN) Compel (CMPL) Counterclaim (CTCL) Assess Court Costs Crossclaim (list on back) (CRSS) Assess Court Costs Dismiss (DISM) Assess Court Costs Exempt/Waive Mediation (EXMD) Extend Statute Of Limitations, Rule 9 (ESOL) Extend Time For Complaint (EXCO) Failure To Join Necessary Party (FJNP) Failure To State A Claim (FASC) Implementation Of Wage Withholding In Non-IV-D Cases (OTHR) Improper Venue/Division (IMVN) Including Attorney's Fees (ATTY) Intervene (INTR) Interplead (OTHR) Lack Of Jurisdiction (Person) (LJPN) Lack Of Jurisdiction (Subject Matter) (LJSM) Modification Of Child Support In IV-D Actions (MSUP) Notice Of Dismissal With Or Without Prejudice (VOLD) Petition To Sue As Indigent (OTHR) Rule 12 Motion In Lieu Of Answer (MDLA) Sanctions (SANC) Set Aside (OTHR) Show Cause (SHOW) Transfer (TRFR) Third Party Complaint (list Third Party Defendants on back) (TPCL) Vacate/Modify Judgment (VCMD) Withdraw As Counsel (WDCN) Other (specify and list each separately) 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 either include a General Civil (AOC-CV-751), Motion (AOC-CV-752), or Court Action (AOC-CV-753) cover sheet. (Over) American LegalNet, Inc. www.FormsWorkFlow.com AOC-CV-751, Rev. 1/14 � 2014 Administrative Office of the Courts CLAIMS FOR RELIEF Administrative Appeal (ADMA) Appointment Of Receiver (APRC) Attachment/Garnishment (ATTC) Claim And Delivery (CLMD) Collection On Account (ACCT) Condemnation (CNDM) Contract (CNTR) Discovery Scheduling Order (DSCH) Injunction (INJU) Date Limited Driving Privilege - Out-Of-State Convictions (PLDP) Medical Malpractice (MDML) Minor Settlement (MSTL) Money Owed (MNYO) Negligence - Motor Vehicle (MVNG) Negligence - Other (NEGO) Motor Vehicle Lien G.S. 44A (MVLN) Possession Of Personal Property (POPP) Signature Of Attorney/Party Product Liability (PROD) Real Property (RLPR) Specific Performance (SPPR) Other (specify and list each separately) FEES IN G.S. 7A-308 APPLY Assert Right Of Access (ARAS) Substitution Of Trustee (Judicial Foreclosure) (RSOT) Supplemental Procedures (SUPR) PRO HAC VICE FEES APPLY Motion For Out-Of-State Attorney To Appear In NC Courts In A Civil Or Criminal Matter (Out-Of-State Attorney/Pro Hac Vice Fee) No. Additional Plaintiff(s) No. Additional Defendant(s) Third Party Defendant(s) Summons Submitted Yes Yes Yes Yes Yes No No No No No Plaintiff(s) Against Whom Counterclaim Asserted Defendant(s) Against Whom Crossclaim Asserted AOC-CV-751, Side Two, Rev. 1/14 � 2014 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com