STATE OF NORTH CAROLINA County Name And Address Of Plaintiff File No. In The General Court Of Justice District Court Division Name And Address Of Defendant VERSUS NO-CONTACT ORDER FOR STALKING OR NONCONSENSUAL SEXUAL CONDUCT G.S. 50C-7 FINDINGS This matter was heard by the undersigned district court judge, the court has jurisdiction over the parties and subject matter, and the defendant has been provided notice of the hearing. The Court hereby finds that: 1. (If this block is checked, skip to the Order portion of the Order.) This Order is entered by default for the remedy sought in the complaint because the defendant failed to file an answer appear at this hearing and the allegations in the complaint are sufficient to justify a no-contact order for stalking or nonconsensual sexual conduct. 2. Present at the hearing were: the plaintiff, represented by the defendant, represented by . . 3. The plaintiff has suffered unlawful conduct by the defendant in that: 4. Other: CONCLUSIONS 1. The defendant committed acts of unlawful conduct against the plaintiff. 2. The plaintiff has failed to prove grounds for issuance of a no-contact order. ORDER It is ORDERED that: 1. The defendant shall not visit, assault, molest, or otherwise interfere with the plaintiff. 2. The defendant cease stalking the plaintiff. 3. The defendant cease harassment of the plaintiff. 4. The defendant not abuse or injure the plaintiff. 5. The defendant not contact the plaintiff by telephone, written communication, or electronic means. 6. The defendant not enter or remain present at the plaintiff's residence, place of employment, and other places listed below at times when the plaintiff is present. List Other Places Where Defendant Ordered Not To Be AOC-CV-524, Rev. 10/15 © 2015 Administrative Office of the Courts (Over) American LegalNet, Inc. www.FormsWorkFlow.com 7. Other: (specify) 8. The terms of this Order shall be effective until (specify date and time if less than one year) one (1) year from the date of this Order. . Name Of District Court Judge (type or print) AM PM Signature Of District Court Judge 9. The Order is denied and the case is dismissed. Date Time NOTICE TO DEFENDANT: A KNOWING VIOLATION OF A CIVIL NO-CONTACT ORDER SHALL BE PUNISHABLE AS CONTEMPT OF COURT, WHICH MAY RESULT IN A FINE OR IMPRISONMENT. THE COURT MAY FIND YOU IN CIVIL OR CRIMINAL CONTEMPT. CERTIFICATION I certify this Order is a true copy. Date Signature Of Clerk Deputy CSC Clerk Of Superior Court Assistant CSC NOTE TO CLERK: G.S. 50C-9 provides: "The clerk of court shall deliver on the same day that a civil no-contact order is issued, a certified copy of that order to the sheriff." The statute also provides that a copy of the order shall be issued promptly to the police department of the municipality of the victim's residence, or the sheriff and any county police department if the victim does not live within a municipality with a police department. RETURN/CERTIFICATE OF SERVICE WHEN DEFENDANT NOT PRESENT AT HEARING I certify that this No-Contact Order For Stalking Or Nonconsensual Sexual Conduct was received and served as follows: Date Served Time Served AM PM Name Of Defendant By delivering to the defendant named above a copy of this Order. By leaving a copy of this Order 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 By mailing a copy of this Order to the defendant by registered mail. certified mail (return receipt). Defendant WAS NOT served for the following reason. Date Received Date Of Return Date Mailed designated delivery service. Signature Of Deputy Sheriff Making Return Name Of Sheriff (type or print) County Of Sheriff Signature Of Clerk Deputy CSC Assistant CSC Clerk Of Superior Court NOTE TO CLERK: G.S. 50C-9(b) provides: "If the [defendant] was not present in court when the order was issued, the [defendant] may be served in the manner provided for service of process in civil proceedings in accordance with Rule 4(j) of the Rules of Civil Procedure." AOC-CV-524, Side Two, Rev. 10/15 © 2015 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com