File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Court Division Name And Address Of Petitioner JUVENILE SUMMONS Name And Address Of Petitioners Attorney EMANCIPATION PROCEEDING G.S. 7A-717 through 7A-726 Date Last Summons Issued Alias and Pluries Summons VERSUS Name And Address Of Respondent 1 Name And Address Of Respondent 2 Parent Guardian Custodian Parent Guardian Custodian To Each Of The Respondent(s) Named Above: SUMMONS AND NOTICE OF HEARING ON PETITION The petitioner named above has petitioned the court for a judicial decree of emancipation! You are SUMMONED to appear on the date and at the time and place set forth below for a hearing on the attached petition. You are notified to answer the petition of the petitioner as follows: 1. File the original of your written answer with the Clerk of Superior Court of the county named above within thirty (30) days after you are served with this summons and petition. 2. Serve a copy of your written answer to the petition on the petitioner or petitioners attorney within thirty (30) days after you have been served. You may serve your answer by delivering a copy to the petitioner (or petitioners attorney) or by mailing it to the petitioners last known address (or the petitioners attorney, if any, at address given above). If you fail to answer the petition, the petitioner will apply to the Court for a decree of emancipation. NOTICE OF HEARING Date Of Hearing Time Of Hearing Date Issued Time AM PM AM PM Place Of Hearing Signature Deputy CSC Assistant CSC Clerk Of Superior Court Date Of Endorsement Time ENDORSEMENT AM PM This Summons was originally issued on the date Signature indicated above and returned not served. At the request of the petitioner, the time within which this Summons must be served is extended thirty (30) days. Deputy CSC Assistant CSC Clerk Of Superior Court AOC-J-910M, New 11/96 1997 Administrative Office of the Courts (Over) >>>> 2 RETURN OF SERVICE I certify that this Summons and a copy of the petition were received and served as follows: RESPONDENT 1Date Served Name Of Respondent 1 By delivering to the respondent named above a copy of the summons and petition. By leaving a copy of the summons and petition at the dwelling house or usual place of abode of the respondent named above with a person of suitable age and discretion then residing therein. Name Of Person With Whom Copies Left Other manner of service (specify) Respondent WAS NOT served for the following reason: RESPONDENT 2Date Served Name Of Respondent 2 By delivering to the respondent named above a copy of the summons and petition. By leaving a copy of the summons and petition at the dwelling house or usual place of abode of the respondent named above with a person of suitable age and discretion then residing therein. Name Of Person With Whom Copies Left Other manner of service (specify) Respondent WAS NOT served for the following reason: Date Received Name Of SheriffDate Of Return County Deputy Sheriff Making Return AOC-J-910M, Side Two, New 11/96 1997 Administrative Office of the Courts