(TYPE OR PRINT IN BLACK INK) Court File No. STATE OF NORTH CAROLINA IV-D Case No. County In The General Court Of Justice District Court Division Name Of Plaintiff PETITION FOR REINSTATEMENT VERSUS OF LICENSING PRIVILEGES Name Of Defendant G.S. 50-13.12(d), 110-142.2(e) REQUEST FOR REINSTATEMENT OF LICENSING PRIVILEGES I hereby request that the Court reinstate the licensing privileges listed below, which were revoked based on my failure to pay child support. I agree to continue to pay the full amount of my current child support obligation as it becomes due and to pay over time the full amount of any delinquent support that I owe under the court order. Type(s) Of License 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 Hunting Fishing Trapping Occupational, Business or Professional Occupational, Business or Professional Occupational, Business or Professional 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 Driving Motor Vehicle Registration (IV-D only) Date Of Birth Name And Address Of Obligor Race Sex Date Signature Of Obligor NOTICE OF HEARING Notice is hereby given that a hearing will be held on this Petition for Reinstatement of Licensing Privileges at the date, time and place shown below. Date Of Hearing Time Of Hearing Signature AM PM Place Of Hearing Deputy CSC Assistant CSC Clerk Of Superior Court NOTE: Complete Certificate Of Service on reverse. AOC-CV-651, Rev. 3/09 © 2009 Administrative Office of the Courts (Over) American LegalNet, Inc. www.FormsWorkflow.com CERTIFICATE OF SERVICE I certify that a copy of this Notice Of Hearing was served by depositing a copy enclosed in a postpaid properly addressed wrapper in a post office or official depository under the exclusive care and custody of the U.S. Postal Service directed to obligee obligee's attorney delivering a copy personally to IV-D agency obligee at address shown below. IV-D agency at address shown below. leaving a copy at the obligee's attorney's office with a partner or employee at the address shown below. Name And Address To Which Notice Sent Date Served Signature Of Person Serving Notice Title AOC-CV-651, Side Two, Rev. 3/09 © 2009 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkflow.com