STATE OF NORTH CAROLINA County Name Of Juvenile File No. IN THE MATTER OF: In The General Court Of Justice District Court Division SUMMONS IN PROCEEDING FOR TERMINATION OF PARENTAL RIGHTS ALIAS AND PLURIES SUMMONS G.S. 7B-1106 Date Original Summons Issued Name And Address Of Respondent 1 Date(s) Subsequent Summons(es) Issued Name And Address Of Respondent 2 Parent (mother) Parent (father) Guardian Custodian Parent (mother) Parent (father) Guardian Custodian DSS or other child-placing agency Name And Address Of Respondent 3 DSS or other child-placing agency Name And Address Of Respondent 4 Parent (mother) Parent (father) Guardian Custodian Parent (mother) Parent (father) Guardian Custodian DSS or other child-placing agency DSS or other child-placing agency TO EACH OF THE RESPONDENT(S) NAMED ABOVE: You are summoned and notified to answer the attached petition in which the petitioner asks the Court to terminate the parental rights of the above named parent(s) to the above named juvenile. Any written answer to the petition must be filed within thirty (30) days after service on you of this summons and a copy of the petition. A copy of the answer must also be served on the petitioner or his/her lawyer. The Court will conduct a hearing to determine whether one or more grounds alleged in the petition for terminating parental rights exist. If the Court finds that one or more grounds exist, the Court will proceed at that hearing or a later hearing to determine whether parental rights should be terminated. Notice of the date, time and location of the hearing will be mailed to you by the petitioner after you file an answer or thirty (30) days from the date of service if you do not file an answer. ADDITIONAL NOTICE TO THE PARENT(S) NAMED ABOVE: If you do not file a written answer to the attached petition with the Clerk of Superior Court within thirty (30) days, the Court may terminate your parental rights. You have a right to be represented by a lawyer in this case. If you want a lawyer and cannot afford one, the Court will appoint a lawyer for you. If you are represented by a lawyer appointed previously in an abuse, neglect or dependency case, that lawyer will continue to represent you unless the Court orders otherwise. If you are not represented by a lawyer and want a court appointed lawyer, you are encouraged to contact immediately the following lawyer who has been temporarily assigned to represent you. At the first hearing, the Court will determine whether you qualify for a court-appointed lawyer. If you do not qualify, the lawyer named below will be released. (NOTE: If a lawyer is appointed for you and if the Court terminates your parental rights, you may become liable for repayment of the lawyer's fees, and a judgment for the amount of the fees may be entered against you.) You are entitled to attend any hearing affecting your parental rights. As described above, the petitioner will mail you notice of the date, time, and location of the hearing. Name And Address Of Mother's Lawyer Name And Address Of Father's Lawyer Telephone Number Of Lawyer Name And Address Of Lawyer For Petitioner Telephone Number Of Lawyer Date Summons Issued Signature Time AM PM This Summons was originally issued on the date indicated above and returned not served. At the request of the petitioner, the time within which this Summons must be served is extended sixty (60) days. ENDORSEMENT Deputy CSC Date Of Endorsement Signature Deputy CSC Assistant CSC Time Clerk Of Superior Court AM PM Assistant CSC Clerk Of Superior Court AOC-J-208, Rev. 3/12 (Replaces J-201) © 2012 Administrative Office of the Courts (Over) American LegalNet, Inc. www.FormsWorkFlow.com I certify that this Summons, a copy of the petition, and any attached Affidavit As To Status Of Minor Child were received and served by personally delivering to each person named below a copy of the same. Date Served RETURN OF SERVICE RESPONDENT 1 Name Of Respondent 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 And Address Of Person With Whom Copies Left Respondent WAS NOT served for the following reason: Date Served RESPONDENT 2 Name Of Respondent 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 And Address Of Person With Whom Copies Left Respondent WAS NOT served for the following reason: Date Served RESPONDENT 3 Name Of Respondent 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 And Address Of Person With Whom Copies Left Respondent WAS NOT served for the following reason: Date Served RESPONDENT 4 Name Of Respondent 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 And Address Of Person With Whom Copies Left Respondent WAS NOT served for the following reason: Date Received Name Of Sheriff Date Of Return County Deputy Sheriff Making Return AOC-J-208, Side Two, Rev. 3/12 (Replaces J-201) © 2012 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com