Request For Certification Of Reinstatement And Certificate Authorizing Reinstatement Of Licensing Privileges
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Request For Certification Of Reinstatement And Certificate Authorizing Reinstatement Of Licensing Privileges Form. This is a North Carolina form and can be use in Civil Statewide.
Tags: Request For Certification Of Reinstatement And Certificate Authorizing Reinstatement Of Licensing Privileges, CV-653, North Carolina Statewide, Civil
Court File No.
(TYPE OR PRINT IN BLACK INK)
STATE OF NORTH CAROLINA
IV-D Case No.
County
In The General Court Of Justice
District Court Division
Name Of Plaintiff
VERSUS
REQUEST FOR CERTIFICATION
OF REINSTATEMENT AND
CERTIFICATE
AUTHORIZING REINSTATEMENT
OF LICENSING PRIVILEGES
Name Of Defendant
Name And Address Of Obligor
Date Of Birth
Race
Sex
G.S. 50-13.12; 110-142.2
REQUEST FOR REINSTATEMENT OF LICENSING PRIVILEGES
I hereby request reinstatement of the licensing privileges listed below, which were revoked based on my failure to pay
child support. I am no longer delinquent in paying court-ordered child support.
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
Signature Of Obligor
CERTIFICATE AUTHORIZING REINSTATEMENT OF LICENSING PRIVILEGES
I hereby certify pursuant to G.S. 50-13.12(c) or G.S. 110-142(d) that the above-named obligor is no longer delinquent in
child support and is eligible for reinstatement of any licensing privileges which were revoked on the basis of his/her failure
to pay child support.
Date
Signature
Deputy CSC
Assistant CSC
Clerk Of Superior Court
IV-D Agency
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
Assistant CSC
Clerk Of Superior Court
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
licensing agency(ies) shown above.
Date Of Mailing
Date Of Certificate
Signature
Assistant CSC
Clerk Of Superior Court
AOC-CV-653, Rev. 3/09
© 2009 Administrative Office of the Courts
Deputy CSC
IV-D Agency
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