File No. STATE OF NORTH CAROLINA County In The General Court Of Justice Superior Court Division Before The Clerk Name Of Petitioner(s) SPECIAL PROCEEDINGS SUMMONS ALIAS AND PLURIES SUMMONS G.S. 1-394 VERSUS Date Original Summons Issued Name Of Respondent(s) Date(s) Subsequent Summons(es) Issued To Each Of The Respondent(s) Named Below: Name And Address Of Respondent 1 Name And Address Of Respondent 2 A Special Proceeding Has Been Commenced Against You! You are notified to appear and answer the attached petition as follows: 1. File a written answer in the office of the Clerk of Superior Court for the county named above within 10 days of the date you were served. 2. Serve a copy of your written answer on the petitioner or the petitioners attorney by personal delivery or mail at the address listed below. If you fail to answer the petition, the petitioner may apply to the Court for the relief demanded in the petition. Name And Address Of Petitioners Attorney (If None, Address Of Petitioner)Date Issued Time Issued AM PM 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 sixty (60) Deputy CSC Assistant CSC Clerk Of Superior Court days. AOC-SP-100, Rev. 7/04 Original-File Copy-Each Respondent Copy-Attorney/Petitioner (Over) 2004 Administrative Office of the Courts >>>> 2 RETURN OF SERVICE I certify that this Summons and a copy of the petition were received and served as follows:Date Served Time Served RESPONDENT 1Name Of Respondent AM PM 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 (if corporation, give title of person copies left with) Service accepted by respondent Date Accepted Signature Other manner of service (specify) Respondent WAS NOT served for the following reason: RESPONDENT 2Date Served Time Served Name Of Respondent AM PM 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 (if corporation, give title of person copies left with) Service accepted by respondent Date Accepted Signature Other manner of service (specify) Respondent WAS NOT served for the following reason: Date Received Signature Of Deputy Sheriff Making ReturnDate Of Return Name Of Deputy Sheriff (Type Or Print) County Of Sheriff AOC-SP-100, Rev. 7/04 2004 Administrative Office of the Courts