STATE OF NORTH CAROLINA County Court File No. IV-D Case No. In The General Court Of Justice District Court Division Name Of Plaintiff VERSUS Name Of Defendant Name And Address Of Obligor ORDER AUTHORIZING REINSTATEMENT OF OBLIGOR'S LICENSING PRIVILEGES Race Sex Date Of Birth G.S. 50-13.12; 110-142.2 The Court makes the following findings of fact and conclusions of law based on the record and the evidence presented. FINDINGS 1. This matter is before the Court on the obligor's petition for reinstatement of licensing privileges. Proper notice of the hearing on this petition was given to the obligee. (date) 2. The following licensing privileges of the obligor were revoked by the Court on pursuant to G.S. 50-13.12 or G.S. 110-142.2 based on the obligor's willful failure to pay court-ordered child support. Hunting Driving Other (specify) Fishing Trapping 3. The obligor has agreed to continue to pay the full amount of his/her current child support obligation as it becomes due and to pay over time the full amount of the delinquent support that he/she owes. CONCLUSION Based on the foregoing Findings, the Court, in the exercise of its discretion, concludes that some or all of the obligor's licensing privileges should be reinstated under G.S. 50-13.12(d) or G.S. 110-142.2(e). ORDER It is hereby ORDERED that: 1. The following licensing privileges of the obligor are hereby REINSTATED and, upon receipt of this Order, the appropriate licensing board shall reinstate the obligor's license if the obligor is otherwise eligible for a license and meets any other requirements of law regarding reinstatement of his/her licensing privileges. Type(s) of License Hunting Fishing Trapping Occupational, Business or Professional Occupational, Business or Professional Occupational, Business or Professional Driving Motor Vehicle Registration ( IV-D only) License Number(s) Name And Address Of Issuing Agency N. C. Wildlife Resources Commission, 1707 Mail Service Center, Raleigh, NC 27699-1707 N. C. Wildlife Resources Commission, 1707 Mail Service Center, Raleigh, NC 27699-1707 N. C. Wildlife Resources Commission, 1707 Mail Service Center, Raleigh, NC 27699-1707 N. C. Division of Motor Vehicles, 1320 Mail Service Center, Raleigh, NC 27699-1320 N. C. Division of Motor Vehicles, 1320 Mail Service Center, Raleigh, NC 27699-1320 3/09 AOC-CV-652, Rev. 11/08 2009 © 2008 Administrative Office of the Courts (Over) American LegalNet, Inc. www.FormsWorkFlow.com This reinstatement is subject to the following terms and conditions. First, that the obligor shall continue to pay current child support in the amount shown below. Second, that the obligor shall pay the full amount of the delinquency owed under said order by making additional payments as shown below and continuing until all delinquencies under said order are paid. Amount Of Current Support Obligation Additional Payment On Delinquency Total Amount Due (Beginning Biweekly Other (specify) Date) $ Weekly Monthly $ $ 0.00 2. A true copy of this Order constitutes the "certification" referred to in G.S. 50-13.12(d) and G.S. 110-142.2(e), (f), and (g). The Clerk or IV-D agency shall provide a copy of this Order to the obligor. Upon request of the obligor, the clerk, or IV-D agency shall mail a copy of this certification to the appropriate agency. Date Order Entered (if different from date signed) Date Signed Signature Of Presiding Judge Name Of Presiding Judge (Type Or Print) CERTIFICATION I certify that this is a true copy of an original order on file in the office of the Clerk of Superior Court. Date Of Certificate Signature Deputy CSC Clerk Of Superior Court Assistant CSC IV-D Agency CERTIFICATE OF MAILING At the request of the obligor, a copy of this Order was mailed by first class mail on the date shown below to the agency(ies) shown on the reverse side. Date Of Mailing Signature Date Of Certificate Deputy CSC Clerk Of Superior Court Assistant CSC IV-D Agency AOC-CV-652, Side Two, Rev. 3/09 © 2009 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com