File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Court Division IN THE MATTER OF: Name Of Juvenile MOTION AND ORDER TO SHOW CAUSE (PARENT, GUARDIAN, CUSTODIAN OR CARETAKER IN ABUSE/NEGLECT/DEPENDENCY CASE) G.S. 5A-23, 7B-407, 7B-904(e) Name And Address Of Person To Appear Parent Guardian Custodian Caretaker I, the undersigned, request the Court to issue an order requiring the person (parent, guardian, custodian or caretaker) named above to appear and show cause why he/she should not be held in civil or criminal contempt. The Order below is issued on the Courts own motion. The basis for this Motion is: 1. The failure of the person named above to appear on (date) in obedience to a summons and petition personally served on him/her in this case. 2. The willful failure of the person named above to comply with an order of the Court entered (date) , by: (describe conduct) VERIFICATION (Unless Order Entered On Courts Own Motion) I, the undersigned, being first duly sworn, say that I have read this Motion and the contents are true to my own knowledge, except as to those matters stated upon information and belief, and as to those, I believe them to be true. Signature Of Person Making Motion SWORN AND SUBSCRIBED TO BEFORE ME Date Name And Title Of Person Making Motion (Type Or Print) Signature Of Person Authorized To Administer Oaths Address City, State, Zip Deputy CSC Assistant CSC Clerk Of Superior Court Magistrate Date My Commission Expires Telephone No. SEAL Notary ORDER TO APPEAR AND SHOW CAUSE TO THE PARENT, GUARDIAN, CUSTODIAN OR CARETAKER NAMED ABOVE: The Court finds probable cause to believe that you are in civil or criminal contempt; therefore, YOU ARE ORDERED TO APPEAR IN PERSON on the date and at the time and place shown below to show cause why you should not be held in civil or criminal contempt for the reason stated in the above motion. Date To Appear Time To Appear Place To Appear AM PM l If the Court holds you in civil contempt, you may be committed to jail until you satisfy purge conditions set by the Court. l If the Court holds you in criminal contempt, you may be committed to jail for up to thirty (30) days, ordered to pay a fine, or both. You are entitled to have a lawyer represent you at the hearing. The Juvenile is not required to appear unless ordered by the Court. Date Name Of District Court Judge (Type Or Print) Signature Of District Court Judge AOC-J-155, New 11/2000 2000 Administrative Office of the Courts (Over) >>>> 2 RETURN OF SERVICE I certify that this Motion and Order was received and served as follows:Date Served Name Of Parent/Guardian/Custodian/Caretaker By delivering to the parent, guardian, custodian or caretaker named above a copy of the Motion and Order. By leaving a copy of the Motion and Order at the dwelling house or usual place of abode of the parent, guardian, custodian or caretaker named above with a person of suitable age and discretion then residing therein.Name And Address Of Person With Whom Copy Left Other manner of service (specify) Person WAS NOT served for the following reason: Date Received Name Of Sheriff (Type Or Print)Date Of Return County Signature Of Deputy Sheriff Making Return Name Of Deputy Sheriff Making Return (Type Or Print) AOC-J-155, Side Two, New 11/2000 2000 Administrative Office of the Courts