File No. LIMITED DRIVING PRIVILEGE -SPEEDING, RECKLESS DRIVING, ORAGGRESSIVE DRIVING -OUT-OF-STATE OR FEDERAL CONVICTIONSG.S. 20-16(a)(9), (a)(10), (a)(10a), (e1); 20-16.1 STATE OF NORTH CAROLINA CountyIn The General Court Of JusticeDistrict Court DivisionIN THE MATTER OF Name And Address Of Applicant NOTE: THIS IS A CIVIL ACTION. Use this form in District Court when the applicant222s license is suspended under any of the following statutes and all of the convictions causing the suspension occurred in another state or in federal court: G.S. 20-16(a)(9) (two or more speeding in excess of 55 m.p.h. and not more than 80 m.p.h., or one or more reckless driving and one or more speeding in excess of 55 m.p.h. and not more than 80 m.p.h., or one or more aggressive driving and one or more speeding in excess of 55 m.p.h. and not more than 80 m.p.h.); G.S. 20-16(a)(10) (operating at a speed in excess of 75 m.p.h. where maximum speed is less than 70 m.p.h.); G.S. 20-16(a)(10a) (operating at a speed in excess of 80 m.p.h. where limit is 70 m.p.h.). Use this form in District Court when the applicant222s license is suspended for an offense covered by G.S. 20-16.1(a) that occurred in another state or in a federal court.Eye ColorDate Of BirthRaceSexHeightWeight Hair ColorOffense(s) For Which Applicant Was ConvictedGeographical RestrictionDriving Hours AllowedType Of VehicleDrivers License No. And StateDate(s) Of Conviction(s)The applicant has been convicted of the offense(s) shown above and the applicant222s drivers license has been revoked. 1. The Court finds that the applicant is eligible for, and in its discretion concludes that the applicant should be issued, a limited driving privilege. The Court has been furnished a properly eecuted form D-12 and is satised that the applicant is nancially responsible. The applicant has eecuted form D-12 and is not reuired to furnish proof of nancial responsibility. 2. The Court nds that the applicant has not satised the eligibility reuirements and should not be issued a limited driving privilege at this time. 1. It is ORDERED that the applicant be allowed a limited driving privilege to operate a non-commercial motor vehicle under the following conditions and under no other circumstances. 2 It is ORDERED that the applicant NOT be allowed a limited driving privilege at this time.This limited driving privilege authorizes the applicant to drive only if the applicant222s license is suspended solely for the above referenced offense(s), and only for the duration of that revocation or for the period shown below, whichever is shorter. This limited driving privilege is subject to such further orders as the Court may deem necessary and proper. It is conditioned upon the maintenance of financial responsibility. FINDINGS ORDER SignatureDate Deputy CSC Asst. CSC Clerk Of Superior CourtI certify that this is a true and complete copy of the original on le in this case.I have received a copy of this limited driving privilege, which contains the restrictions on my driving privilege. I understand that this is my limited license to drive; that I must keep it in my possession during the period of revocation; that if my drivers license is revoked for any other reason, this limited driving privilege is invalid; and that a violation of any restriction imposed in connection with this limited driving privilege constitutes the offense of driving while license revoked under G.S. 20-28(a). Signature Of ApplicantDate CERTIFICATION NOTICE/ACKNOWLEDGMENT OF RECEIPT Additional Restrictions: Corrective Lenses 45 M.P.H. Only Daylight Only Other: (specify) Signature Of JudgeName Of Judge (type or print) Date Of OrderEffective FromTo Original-ile Certied Copy-Defendant Copy-DM AOC-CV-351, Rev. 4/18 2018 Administrative Ofce of the Courts American LegalNet, Inc. www.FormsWorkFlow.com