small claims forms - unc school of government claims forms ... have the opportunity at the trial to...
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Small Claims Forms
(These and other forms can be found at the www.nccourts.org webpage)
AOC-CVM-100 Magistrate Summons AOC-CVM-200 Complaint for Money Owed AOC-CVM-201 Complaint in Summary Ejectment AOC-CVM-202 Complaint to Recover Possession of Personal Property AOC-CVM-203 Complaint To Enforce Possessory Lien On Motor Vehicle AOC-CVM-400 Judgment In Action To Recover Money Or Personal Property AOC-CVM-401 Judgment In Action For Summary Ejectment AOC-CVM-402 Judgment In Action On Possessory Lien On MotorAOC-CV-415 Motion to Claim Exempt Property AOC-G-108 Order
Forms - Page 1
Forms - Page 2
File No.STATE OF NORTH CAROLINA
Deputy CSC Assistant CSC Clerk Of Superior Court
TO: TO:
MAGISTRATE SUMMONS
Plaintiff(s)
(Over)
VERSUSDefendant(s)
County
G.S. 7A-217, -232; 1A-1, Rule 4
In The General Court Of Justice District Court Division - Small Claims
ALIAS AND PLURIES SUMMONS (ASSESS FEE)
A Small Claim Action Has Been Commenced Against You!
Date Original Summons Issued
Date(s) Subsequent Summons(es) Issued
You are notified to appear before the magistrate at the specified date, time and location of trial listed below. You will have the opportunity at the trial to defend yourself against the claim stated in the attached complaint.
You may file a written answer, making defense to the claim, in the office of the Clerk of Superior Court at any time beforethe time set for trial. Whether or not you file an answer, the plaintiff must prove the claim before the magistrate.
If you fail to appear and defend against the proof offered, the magistrate may enter a judgment against you.
Name And Address Of Plaintiff Or Plaintiff's Attorney
Date of TrialAM PM
Signature
Name And Address Of Defendant 1 Name And Address Of Defendant 2
Date Issued
Time Of Trial
AOC-CVM-100, Rev. 6/11© 2011 Administrative Office of the Courts
Location Of Court
Service was made by mailing by first class mail a copy of the summons and complaint to the defendant(s) and by posting a copy of the summons and complaint at the following premises.
Defendant WAS NOT served for the following reason:
Other manner of service: (specify).
By delivering to the defendant named above a copy of the summons and complaint.
By leaving a copy of summons and complaint at the dwelling house or usual place of abode of the defendant named above with a person of suitable age and discretion then residing therein.
As the defendant is a corporation, service was effected by delivering a copy of the summons and complaint to the person named below.
PM AM
Defendant WAS NOT served for the following reason:
Other manner of service: (specify).
By delivering to the defendant named above a copy of the summons and complaint.
By leaving a copy of summons and complaint at the dwelling house or usual place of abode of the defendant named above with a person of suitable age and discretion then residing therein.
As the defendant is a corporation, service was effected by delivering a copy of the summons and complaint to the person named below.
PM AM
AOC-CVM-100, Side Two, Rev. 6/11© 2011 Administrative Office of the Courts
FOR USE IN SUMMARY EJECTMENT CASES ONLY
Signature Of Deputy Sheriff Making Return
DEFENDANT 1
I certify that this Summons and a copy of the complaint were received and served as follows:RETURN OF SERVICE
DEFENDANT 2
Service Fee
$
Date Served
Address Of Premises Where Posted
Date Of Return
Date Received
Name(s) Of The Defendant(s) Served By Posting
Name Of Sheriff (Type Or Print)
County Of Sheriff
Name And Address Of Person With Whom Copy Left (If Corporation, Give Title Of Person Copy Left With)
Name Of DefendantDate Served
Name And Address Of Person With Whom Copy Left (If Corporation, Give Title Of Person Copy Left With)
Name Of DefendantDate Served
Time Served
Time Served
Inte
rest
Ow
ed (i
f any
)
Prin
cipa
l Am
ount
Ow
ed
Tota
l Am
ount
Ow
ed
Nam
e A
nd A
ddre
ss O
f Def
enda
nt 1
Indi
vidu
alC
orpo
ratio
n
Nam
e A
nd A
ddre
ss O
f Def
enda
nt 2
Indi
vidu
alC
orpo
ratio
n
Oth
er:(
spec
ify)
For c
onve
rsio
n (d
escr
ibe
prop
erty
)
(Ove
r)
For a
Wor
thle
ss C
heck
(atta
ch a
cop
y of
the
chec
k)
On
An
Acc
ount
(atta
ch a
cop
y of
the
acco
unt)
For G
oods
Sol
d A
nd D
eliv
ered
Bet
wee
n
For M
oney
Len
t
On
a P
rom
isso
ry N
ote
(atta
ch c
opy)
Inte
rest
Rat
e
Inte
rest
Rat
e
Inte
rest
Rat
e
STA
TE O
F N
OR
TH C
AR
OLI
NA
In T
he G
ener
al C
ourt
Of J
ustic
eD
istri
ct C
ourt
Div
isio
n-S
mal
l Cla
ims
Cou
nty
CO
MPL
AIN
TFO
R M
ON
EY O
WED G.S
. 7A
-216
, 7A
-232
The
defe
ndan
t is
a re
side
nt o
f the
cou
nty
nam
ed a
bove
.
VER
SUS
Sig
natu
re O
f Pla
intif
f Or A
ttorn
eyD
ate
The
defe
ndan
t ow
es m
e th
e am
ount
list
ed fo
r the
follo
win
gre
ason
:
I dem
and
to re
cove
r the
tota
l am
ount
list
ed a
bove
, plu
s in
tere
st a
nd re
imbu
rsem
ent f
or c
ourt
cost
s.
$ $ $
(che
ck o
ne b
elow
)
End
ing
Dat
e
2.1.
AO
C-C
VM
-200
, Rev
. 2/1
2©
201
2 A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
Nam
e A
nd A
ddre
ss O
f Pla
intif
f
Cou
nty
Cou
nty
Cou
nty
Nam
e A
nd A
ddre
ss O
f Pla
intif
f's A
ttorn
eyTele
phon
e N
o.
Tele
phon
e N
o.
Tele
phon
e N
o.
Dat
e Fr
om W
hich
Inte
rest
Due
Beg
inni
ng D
ate
Inte
rest
Rat
e
Dat
e Fr
om W
hich
Inte
rest
Due
Dat
e Fr
om W
hich
Inte
rest
Due
Dat
e O
f Not
e
File
No.
Nam
e O
f Pla
intif
f Or A
ttorn
ey (T
ype
Or P
rint)
Forms - Page 5
The
PLA
INTI
FF m
ust f
ile a
sm
all c
laim
act
ion
in th
e co
unty
whe
re a
t lea
ston
e of
the
defe
ndan
ts re
side
s.
The
PLA
INTI
FF c
anno
t sue
in s
mal
l cla
ims
cour
t for
mor
e th
an $
5,00
0.00
excl
udin
g in
tere
st a
nd c
osts
.
The
PLA
INTI
FF m
ust s
how
the
com
plet
e na
me
and
addr
ess
of th
e de
fend
ant t
o en
sure
ser
vice
on
the
defe
ndan
t. If
ther
e ar
e tw
o de
fend
ants
and
they
resi
de a
t diff
eren
t add
ress
es, t
he p
lain
tiff m
ust i
nclu
de b
oth
addr
esse
s. T
he p
lain
tiff m
ust d
eter
min
e if
the
defe
ndan
t is
a co
rpor
atio
n an
d su
e in
the
com
plet
e co
rpor
ate
nam
e. If
the
busi
ness
is n
ot a
co
rpor
atio
n, th
e pl
aint
iff m
ust d
eter
min
e th
e ow
ner's
nam
e an
d su
e th
e ow
ner.
The
PLA
INTI
FF m
ay s
erve
the
defe
ndan
t(s) b
y m
ailin
g a
copy
of t
he
sum
mon
s an
d co
mpl
aint
by
regi
ster
ed o
r cer
tifie
d m
ail,
retu
rn re
ceip
t re
ques
ted,
add
ress
ed to
the
party
to b
e se
rved
or b
y pa
ying
the
cost
s to
ha
ve th
e sh
eriff
ser
ve th
e su
mm
ons
and
com
plai
nt. I
f cer
tifie
d or
re
gist
ered
mai
l is
used
, the
pla
intif
f mus
t pre
pare
and
file
a s
wor
n st
atem
ent w
ith th
e C
lerk
of S
uper
ior C
ourt
prov
ing
serv
ice
by c
ertif
ied
mai
l and
mus
t atta
ch to
that
sta
tem
ent t
he p
osta
l rec
eipt
sho
win
g th
at th
ele
tter w
as a
ccep
ted.
The
PLA
INTI
FF m
ust p
ay a
dvan
ce c
ourt
cost
s at
the
time
of fi
ling
this
C
ompl
aint
. In
the
even
t tha
t jud
gmen
t is
ente
red
in fa
vor o
f the
pla
intif
f, co
urt c
osts
may
be
char
ged
agai
nst t
he d
efen
dant
.
INST
RU
CTI
ON
S TO
PLA
INTI
FF O
R D
EFEN
DA
NT
1. 2. 3. 4. 5.
AO
C-C
VM
-200
, Rev
. 2/1
2©
201
2 A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
6. 7. 8. 9.
The
DE
FEN
DA
NT
may
file
a w
ritte
n an
swer
, mak
ing
defe
nse
to th
e cl
aim
, in
the
offic
e of
the
Cle
rk o
f Sup
erio
r Cou
rt. T
his
answ
er
shou
ld b
e ac
com
pani
ed b
y a
copy
for t
he p
lain
tiff a
nd b
e fil
ed n
o la
ter t
han
the
time
set f
or tr
ial.
The
filin
g of
the
answ
er D
OE
S N
OT
relie
ve th
e de
fend
ant o
f the
nee
d to
app
ear b
efor
e th
e m
agis
trate
to
asse
rt th
e de
fend
ant's
def
ense
.
Whe
ther
or n
ot a
n an
swer
is fi
led,
the
PLA
INTI
FF m
ust a
ppea
r be
fore
the
mag
istra
te.
The
PLA
INTI
FF o
r the
DE
FEN
DA
NT
may
app
eal t
he m
agis
trate
's
deci
sion
in th
is c
ase.
To
appe
al, n
otic
e m
ust b
e gi
ven
in o
pen
cour
t w
hen
the
judg
men
t is
rend
ered
, or n
otic
e m
ay b
e gi
ven
in w
ritin
g to
th
e C
lerk
of S
uper
ior C
ourt
with
in te
n (1
0) d
ays
afte
r the
judg
men
t is
rend
ered
. If n
otic
e is
giv
en in
writ
ing,
the
appe
alin
g pa
rty m
ust a
lso
serv
e w
ritte
n no
tice
of a
ppea
l on
all o
ther
par
ties.
The
app
ealin
g pa
rty m
ust P
AY
to th
e C
lerk
of S
uper
ior C
ourt
the
cost
s of
cou
rt fo
r ap
peal
with
in tw
enty
(20)
day
s af
ter t
he ju
dgm
ent i
s re
nder
ed.
This
form
is s
uppl
ied
in o
rder
to e
xped
ite th
e ha
ndlin
g of
sm
all
clai
ms.
It is
des
igne
d to
cov
er th
e m
ost c
omm
on c
laim
s.
The
Cle
rk o
r mag
istr
ate
cann
ot a
dvis
e yo
u ab
out y
our
case
or a
ssis
t you
in c
ompl
etin
g th
is fo
rm. I
f you
ha
ve a
ny q
uest
ion s
, you
sho
uld
cons
ult a
n at
torn
ey.
10.
Forms - Page 6
Nam
e A
nd A
ddre
ss O
f Def
enda
nt 2
Ind
ivid
ual
Cor
pora
tion
Nam
e A
nd A
ddre
ss O
f Def
enda
nt 1
Ind
ivid
ual
Cor
pora
tion
File
No.
CER
TIFI
CA
TIO
N W
HEN
CO
MPL
AIN
T SI
GN
ED B
Y A
GEN
T O
F PL
AIN
TIFF
Am
ount
Of R
ent P
ast D
ue
(Ove
r)
The
defe
ndan
t is
a re
side
nt o
f the
cou
nty
nam
ed a
bove
.
Con
vent
iona
lP
ublic
Hou
sing
Sec
tion
8
The
defe
ndan
t fai
led
to p
ay th
e re
nt d
ue o
n th
e ab
ove
date
and
the
plai
ntiff
mad
e de
man
d fo
r the
rent
an
d w
aite
d th
e 10
-day
gra
ce p
erio
d be
fore
filin
g th
e co
mpl
aint
.
The
defe
ndan
t ow
es th
e pl
aint
iff th
e fo
llow
ing:
The
plai
ntiff
has
dem
ande
d po
sses
sion
of t
he p
rem
ises
from
the
defe
ndan
t, w
ho h
as re
fuse
d to
sur
rend
erit,
and
the
plai
ntiff
is e
ntitl
ed to
imm
edia
te p
osse
ssio
n.
I dem
and
to b
e pu
t in
poss
essi
on o
f the
pre
mis
es a
nd to
reco
ver t
he to
tal a
mou
nt li
sted
abo
ve a
nd d
aily
re
ntal
unt
il en
try o
f jud
gmen
t plu
s in
tere
st a
nd re
imbu
rsem
ent f
or c
ourt
cost
s.
Type
Of L
ease
STA
TE O
F N
OR
TH C
AR
OLI
NA
In T
he G
ener
al C
ourt
Of J
ustic
eD
istri
ct C
ourt
Div
isio
n-S
mal
l Cla
ims
Cou
nty
CO
MPL
AIN
TIN
SU
MM
AR
Y EJ
ECTM
ENT
G.S
. 7A
-216
, 7A
-232
; Ch.
42,
Art.
3 a
nd 7
1.
VER
SUS
Tele
phon
e N
o.
AO
C-C
VM
-201
, Rev
. 2/1
2©
201
2 A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
4.
Sig
natu
re O
f Age
nt
The
defe
ndan
t ent
ered
into
pos
sess
ion
of p
rem
ises
des
crib
ed b
elow
as
a le
ssee
of p
lain
tiff.
Des
crip
tion
Of A
ny P
rope
rty D
amag
e
6.
Sig
natu
re O
f Pla
intif
f/Atto
rney
/Age
nt
I cer
tify
that
I am
an
agen
t of t
he p
lain
tiff a
nd h
ave
actu
al k
now
ledg
e of
the
fact
s al
lege
d in
this
Com
plai
nt.
$$
$
The
defe
ndan
t bre
ache
d th
e co
nditi
on o
f the
leas
e de
scrib
ed b
elow
for w
hich
re-e
ntry
is s
peci
fied.
3.
per
Dat
e Le
ase
End
ed
Ora
l
The
leas
e pe
riod
ende
d on
the
abov
e da
te a
nd th
e de
fend
ant i
s ho
ldin
g ov
er a
fter t
he e
nd o
f the
leas
e pe
riod.
Crim
inal
act
ivity
or o
ther
act
ivity
has
occ
urre
d in
vio
latio
n of
G.S
. 42-
63 a
s sp
ecifi
ed b
elow
.
$M
onth
Wee
kW
ritte
n
5.2.
Nam
e A
nd A
ddre
ss O
f Pla
intif
f
Nam
e A
nd A
ddre
ss O
f Pla
intif
f's A
ttorn
ey O
r Age
nt
Cou
nty
Tele
phon
e N
o.
Cou
nty
Cou
nty
Des
crip
tion
Of P
rem
ises
(Inc
lude
Loc
atio
n)
Des
crip
tion
Of B
reac
h/C
rimin
al A
ctiv
ity (g
ive
nam
es, d
ates
, pla
ces
and
illeg
al a
ctiv
ity)
Dat
e R
ent D
ue
Tele
phon
e N
o.
Dat
e
Dat
e
Am
ount
Of D
amag
e (If
Kno
wn)
Tota
l Am
ount
Due
Rat
e O
f Ren
t
Nam
e O
f Pla
intif
f/Atto
rney
/Age
nt (T
ype
Or P
rint)
Nam
e O
f Age
nt (T
ype
Or P
rint)
Forms - Page 7
The
PLA
INTI
FF m
ust f
ile a
sm
all c
laim
act
ion
in th
e co
unty
whe
re a
t lea
st
one
of th
e de
fend
ants
resi
des.
The
PLA
INTI
FF c
anno
t sue
in s
mal
l cla
ims
cour
t for
mor
e th
an $
5,00
0.00
ex
clud
ing
inte
rest
and
cos
ts.
The
PLA
INTI
FF m
ust s
how
the
com
plet
e na
me
and
addr
ess
of th
e de
fend
ant t
o en
sure
ser
vice
on
the
defe
ndan
t. If
ther
e ar
e tw
o de
fend
ants
an
d th
ey re
side
at d
iffer
ent a
ddre
sses
, the
pla
intif
f mus
t inc
lude
bot
h ad
dres
ses.
The
pla
intif
f mus
t det
erm
ine
if th
e de
fend
ant i
s a
corp
orat
ion
and
sue
in th
e co
mpl
ete
corp
orat
e na
me.
If th
e bu
sine
ss is
not
a c
orpo
ratio
n, th
epl
aint
iff m
ust d
eter
min
e th
e ow
ner's
nam
e an
d su
e th
e ow
ner.
The
PLA
INTI
FF m
ay s
erve
the
defe
ndan
t(s) b
y m
ailin
g a
copy
of t
he
sum
mon
s an
d co
mpl
aint
by
regi
ster
ed o
r cer
tifie
d m
ail,
retu
rn re
ceip
t re
ques
ted,
add
ress
ed to
the
party
to b
e se
rved
or b
y pa
ying
the
cost
s to
ha
ve th
e sh
eriff
ser
ve th
e su
mm
ons
and
com
plai
nt. I
f cer
tifie
d or
regi
ster
ed
mai
l is
used
, the
pla
intif
f mus
t pre
pare
and
file
a s
wor
n st
atem
ent w
ith th
e C
lerk
of S
uper
ior C
ourt
prov
ing
serv
ice
by c
ertif
ied
mai
l and
mus
t atta
ch to
th
at s
tate
men
t the
pos
tal r
ecei
pt s
how
ing
that
the
lette
r was
acc
epte
d.
In fi
lling
out
num
ber 3
in th
e co
mpl
aint
, if t
he la
ndlo
rd is
see
king
to re
mov
e th
e te
nant
for f
ailu
re to
pay
rent
whe
n th
ere
is n
o w
ritte
n le
ase,
the
first
blo
cksh
ould
be
chec
ked.
(Def
enda
nt fa
iled
to p
ay th
e re
nt d
ue o
n th
e ab
ove
date
an
d th
e pl
aint
iff m
ade
dem
and
for t
he re
nt a
nd w
aite
d th
e te
n (1
0) d
ay g
race
perio
d be
fore
filin
g th
e co
mpl
aint
.) If
the
land
lord
is s
eeki
ng to
rem
ove
the
tena
nt fo
r fai
lure
to p
ay re
nt w
hen
ther
e is
a w
ritte
n le
ase
with
an
auto
mat
ic
forfe
iture
cla
use,
the
third
blo
ck s
houl
d be
che
cked
. (Th
e de
fend
ant
brea
ched
the
cond
ition
of t
he le
ase
desc
ribed
bel
ow fo
r whi
ch re
-ent
ry is
sp
ecifi
ed.)
And
"fai
lure
to p
ay re
nt" s
houl
d be
pla
ced
in th
e sp
ace
for
desc
riptio
n of
the
brea
ch. I
f the
land
lord
is s
eeki
ng to
evi
ct te
nant
for
viol
atin
g so
me
othe
r con
ditio
n in
the
leas
e, th
e th
ird b
lock
sho
uld
also
be
chec
ked.
If th
e la
ndlo
rd is
cla
imin
g th
at th
e te
rm o
f the
leas
e ha
s en
ded
and
the
tena
nt re
fuse
s to
leav
e, th
e se
cond
blo
ck s
houl
d be
che
cked
. If t
he
land
lord
is c
laim
ing
that
crim
inal
act
ivity
occ
urre
d, th
e fo
urth
blo
ck s
houl
d be
chec
ked
and
the
cond
uct m
ust b
e de
scrib
ed in
spa
ce p
rovi
ded.
AO
C-C
VM
-201
, Sid
e Tw
o, R
ev. 2
/12
© 2
012
Adm
inis
trativ
e O
ffice
of t
he C
ourts
INST
RU
CTI
ON
S TO
PLA
INTI
FF O
R D
EFEN
DA
NT
1. 2. 3. 4. 5.
The
PLA
INTI
FF m
ust p
ay a
dvan
ce c
ourt
cost
s at
the
time
of fi
ling
this
C
ompl
aint
. In
the
even
t tha
t jud
gmen
t is
rend
ered
in fa
vor o
f the
pl
aint
iff, c
ourt
cost
s m
ay b
e ch
arge
d ag
ains
t the
def
enda
nt.
The
PLA
INTI
FF m
ust a
ppea
r bef
ore
the
mag
istra
te to
pro
ve h
is/h
er
clai
m.
The
DE
FEN
DA
NT
may
file
a w
ritte
n an
swer
, mak
ing
defe
nse
to th
e cl
aim
, in
the
offic
e of
the
Cle
rk o
f Sup
erio
r Cou
rt. T
his
answ
er s
houl
d be
acc
ompa
nied
by
a co
py fo
r the
pla
intif
f an d
be
filed
no
late
r tha
n th
e tim
e se
t for
tria
l. Th
e fil
ing
of th
e an
swer
DO
ES
NO
T re
lieve
the
defe
ndan
t of t
he n
eed
to a
ppea
r bef
ore
the
mag
istra
te to
ass
ert t
he
defe
ndan
t's d
efen
se.
The
PLA
INTI
FF o
r the
DE
FEN
DA
NT
may
app
eal t
he m
agis
trate
's
deci
sion
in th
is c
ase.
To
appe
al, n
otic
e m
ust b
e gi
ven
in o
pen
cour
t w
hen
the
judg
men
t is
ente
red,
or n
otic
e m
ay b
e gi
ven
in w
ritin
g to
the
Cle
rk o
f Sup
erio
r Cou
rt w
ithin
ten
(10)
day
s af
t er t
he ju
dgm
ent i
s en
tere
d. If
not
ice
is g
iven
in w
ritin
g, th
e ap
peal
ing
party
mus
t als
o se
rve
writ
ten
notic
e of
app
eal o
n al
l oth
er p
artie
s. T
he a
ppea
ling
party
m
ust P
AY
to th
e C
lerk
of S
uper
ior C
ourt
the
cost
s of
cou
rt fo
r app
eal
with
in tw
enty
(20)
day
s af
ter t
he ju
dgm
ent i
s en
tere
d.
If th
e de
fend
ant a
ppea
ls a
nd w
ishe
s to
rem
ain
on th
e pr
emis
es th
e de
fend
ant m
ust a
lso
post
a s
tay
of e
xecu
tion
bond
with
in te
n (1
0) d
ays
afte
r the
judg
men
t is
ente
red.
This
form
is s
uppl
ied
in o
rder
to e
xped
ite th
e ha
ndlin
g of
sm
all c
laim
s.
It is
des
igne
d to
cov
er th
e m
ost c
omm
on c
laim
s.
6. 7. 8. 9. 10.
11.
The
Cle
rk o
r mag
istr
ate
cann
ot a
dvis
e yo
u ab
out y
our
case
or a
ssis
t you
in c
ompl
etin
g th
is fo
rm.
If yo
u ha
ve
any
ques
tions
, you
sho
uld
cons
ult a
n at
torn
e y.
12.
Forms - Page 8
Nam
e A
nd A
ddre
ss O
f Def
enda
nt 2
I
ndiv
idua
l
Cor
pora
tion
Cou
nty
Tele
phon
e N
o.
Soc
ial S
ecur
ity N
o./T
axpa
yer I
D N
o.
Des
crip
tion
Of P
erso
nal P
rope
rty In
Whi
ch Y
ou H
ave
a S
ecur
ed In
tere
st (A
ttach
Cop
y O
f Sec
urity
Agr
eem
ent)
Dat
e D
efen
dant
Wro
ngfu
lly T
ook
Or K
ept P
rope
rty
Tota
l Val
ue O
f Pro
perty
To
Be
Rec
over
ed
WH
EN P
LAIN
TIFF
IS A
SEC
UR
ED P
AR
TY
Phy
sica
l Dam
age
To P
rope
rty
Orig
inal
-File
C
opy-
Each
Def
enda
nt
Cop
y-At
torn
ey/P
lain
tiff
(Ove
r)
STA
TE O
F N
OR
TH C
AR
OLI
NA
File
No.
In T
he G
ener
al C
ourt
Of J
ustic
eD
istri
ct C
ourt
Div
isio
n-Sm
all C
laim
sC
ount
yC
OM
PLA
INT
TO R
ECO
VER
PO
SSES
SIO
NO
F PE
RSO
NA
L PR
OPE
RTY
G.S
. 7A
-232
; 25-
9-60
9
The
defe
ndan
t is
a re
side
nt o
f the
cou
nty
nam
ed a
bove
. I h
ave
a se
curit
y in
tere
st in
the
pers
onal
pro
perty
de
scrib
ed in
the
atta
ched
sec
urity
agr
eem
ent.
The
tota
l cur
rent
val
ue o
f thi
s pr
oper
ty is
as
show
n be
low
.Th
e de
fend
ant h
as d
efau
lted
in th
e pa
ymen
t of t
he d
ebt w
hich
the
prop
erty
sec
ures
or h
as o
ther
wis
e br
each
ed th
e te
rms
of th
e se
curit
y ag
reem
ent g
ivin
g m
e th
e rig
ht to
cla
im im
med
iate
pos
sess
ion
of th
e pr
oper
ty d
escr
ibed
bel
ow.
I dem
and
reco
very
of t
his
prop
erty
and
reim
burs
emen
t for
cou
rt co
sts.
VER
SUS
Sig
natu
re O
f Pla
intif
f Or A
ttorn
ey
Sig
natu
re O
f Pla
intif
f Or A
ttorn
ey
PLA
INTI
FF A
SEC
UR
ED P
AR
TYPL
AIN
TIFF
NO
T A
SEC
UR
ED P
AR
TY
$
The
defe
ndan
t is
a re
side
nt o
f the
cou
nty
nam
ed a
bove
. Th
e de
fend
ant h
as in
his
/her
pos
sess
ion
the
pers
onal
pro
perty
des
crib
ed b
elow
whi
ch b
elon
gs to
me.
I a
m e
ntitl
ed to
imm
edia
te p
osse
ssio
n of
the
prop
erty
, but
the
defe
ndan
t has
refu
sed
on d
eman
d to
del
iver
it to
me.
The
def
enda
nt h
as u
nlaw
fully
kep
t po
sses
sion
of t
his
prop
erty
sin
ce th
e da
te li
sted
bel
ow a
nd h
as th
eref
ore
depr
ived
me
of it
s us
e. T
he
dam
age
due
me
for t
he lo
ss o
f use
and
phy
sica
l dam
age
to th
e pr
oper
ty is
set
out
bel
ow. I
dem
and
reco
very
of
this
pro
perty
and
dam
ages
in th
e to
tal a
mou
nt s
et o
ut b
elow
, plu
s in
tere
st a
nd re
imbu
rsem
ent f
or c
ourt
cost
s.
WH
EN P
LAIN
TIFF
IS N
OT
A S
ECU
RED
PA
RTY
Des
crip
tion
Of P
erso
nal P
rope
rty Y
ou O
wn
Whi
ch Is
In P
osse
ssio
n O
f Def
enda
nt
$ $ $ $
AO
C-C
VM
-202
, R
ev. 2
/12
© 2
012
Adm
inis
trativ
e O
ffice
of t
he C
ourts
Nam
e A
nd A
ddre
ss O
f Pla
intif
f
Nam
e A
nd A
ddre
ss O
f Def
enda
nt 1
I
ndiv
idua
l
Cor
pora
tion
Cou
nty
Cou
nty
Nam
e A
nd A
ddre
ss O
f Pla
intif
f's A
ttorn
ey
Tele
phon
e N
o.
Tele
phon
e N
o.
Dat
e
Dat
e
Tota
l Val
ue O
f Pro
perty
To
Be
Rec
over
ed
Dam
age
Due
For
Los
s O
f Use
Tota
l Am
ount
Of D
amag
esN
ame
Of P
lain
tiff O
r Atto
rney
(Typ
e O
r Prin
t)
Forms - Page 9
The
DE
FEN
DA
NT
may
file
a w
ritte
n an
swer
, mak
ing
defe
nse
to th
e cl
aim
,in
the
offic
e of
the
Cle
rk o
f Sup
erio
r C
ourt.
Thi
s an
swer
sho
uld
be
acco
mpa
nied
by
a co
py fo
r the
pla
intif
f and
be
filed
no
late
r tha
n th
e tim
e se
t for
tria
l. Th
e fil
ing
of th
e an
swer
DO
ES
NO
T re
lieve
the
defe
ndan
t of
the
need
to a
ppea
r bef
ore
the
mag
istra
te to
ass
ert t
he d
efen
dant
's
defe
nse.
Whe
ther
or n
ot a
n an
swer
is fi
led,
the
PLAI
NTI
FF m
ust a
ppea
r bef
ore
the
mag
istra
te.
The
PLA
INTI
FF o
r the
DE
FEN
DAN
T m
ay a
ppea
l the
mag
istra
te's
de
cisi
on in
this
cas
e. T
o ap
peal
, not
ice
mus
t be
give
n in
ope
n co
urt w
hen
the
judg
men
t is
ente
red,
or n
otic
e m
ay b
e gi
ven
in w
ritin
g to
the
Cle
rk o
f S
uper
ior C
ourt
with
in te
n (1
0) d
ays
afte
r the
judg
men
t is
ente
red.
If n
otic
e is
giv
en in
writ
ing,
the
appe
alin
g pa
rty m
ust a
lso
serv
e w
ritte
n no
tice
of
appe
al o
n al
l oth
er p
artie
s. T
he a
ppea
ling
party
mus
t PA
Y to
the
Cle
rk o
f S
uper
ior C
ourt
the
cost
s of
cou
rt fo
r app
eal w
ithin
twen
ty (2
0) d
ays
afte
r th
e ju
dgm
ent i
s en
tere
d. A
def
enda
nt w
ho a
ppea
ls a
lso
mus
t pos
t a b
ond
to s
tay
exec
utio
n of
the
judg
men
t with
in te
n (1
0) d
ays
afte
r the
judg
emen
t is
ent
ered
.
This
form
is s
uppl
ied
in o
rder
to e
xped
ite th
e ha
ndlin
g of
sm
all c
laim
s. I
t is
des
igne
d to
cov
er th
e m
ost c
omm
on c
laim
s.
The
Cle
rk o
r mag
istra
te c
anno
t adv
ise
you
abou
t you
r cas
e or
ass
ist y
ou
in c
ompl
etin
g th
is fo
rm. I
f you
hav
e an
y qu
estio
ns, y
ou s
houl
d co
nsul
t an
atto
rney
.
The
PLA
INTI
FF m
ust f
ile a
sm
all c
laim
act
ion
in th
e co
unty
whe
re a
t le
ast o
ne o
f the
def
enda
nts
resi
des.
The
PLA
INTI
FF c
anno
t sue
to re
cove
r pro
perty
wor
th m
ore
than
$5
,000
.00.
The
PLA
INTI
FF m
ust s
how
the
com
plet
e na
me
and
addr
ess
of th
e de
fend
ant t
o en
sure
ser
vice
on
the
defe
ndan
t. If
ther
e ar
e tw
o de
fend
ants
and
they
resi
de a
t diff
eren
t add
ress
es, t
he p
lain
tiff m
ust
incl
ude
both
add
ress
es. T
he p
lain
tiff m
ust d
eter
min
e if
the
defe
ndan
t is
a co
rpor
atio
n an
d su
e in
the
com
plet
e co
rpor
ate
nam
e. If
the
busi
ness
is
not
a c
orpo
ratio
n, th
e pl
aint
iff m
ust d
eter
min
e th
e ow
ner's
nam
e an
d su
e th
e ow
ner.
The
PLA
INTI
FF m
ay s
erve
the
defe
ndan
t(s) b
y m
ailin
g a
copy
of t
he
sum
mon
s an
d co
mpl
aint
by
regi
ster
ed o
r cer
tifie
d m
ail,
retu
rn re
ceip
t re
ques
ted,
add
ress
ed to
the
party
to b
e se
rved
or b
y pa
ying
the
cost
s to
hav
e th
e sh
eriff
ser
ve th
e su
mm
ons
and
com
plai
nt. I
f cer
tifie
d or
re
gist
ered
mai
l is
used
, the
pla
intif
f mus
t pre
pare
and
file
a s
wor
n st
atem
ent w
ith th
e C
lerk
of S
uper
ior C
ourt
prov
ing
serv
ice
by c
ertif
ied
mai
l and
mus
t atta
ch to
that
sta
tem
ent t
he p
osta
l rec
eipt
sho
win
g th
at
the
lette
r was
acc
epte
d.
The
PLA
INTI
FF m
ust p
ay a
dvan
ce c
ourt
cost
s at
the
time
of fi
ling
this
C
ompl
aint
. In
the
even
t tha
t jud
gmen
t is
rend
ered
in fa
vor o
f the
pl
aint
iff, c
ourt
cost
s m
ay b
e ch
arge
d ag
ains
t the
def
enda
nt.
INST
RU
CTI
ON
S TO
PLA
INTI
FF O
R D
EFEN
DA
NT
1. 2. 3. 4. 5.
6. 7. 8. 9. 10.
AO
C-C
VM
-202
, R
ev. 2
/12
© 2
012
Adm
inis
trativ
e O
ffice
of t
he C
ourts
Forms - Page 10
STA
TE O
F N
OR
TH C
AR
OLI
NA
(Plu
s St
orag
e @
$
I cam
e in
to p
osse
ssio
n of
the
mot
or v
ehic
le d
escr
ibed
on
the
date
sho
wn
belo
w, a
m in
pos
sess
ion
of
the
vehi
cle,
and
cla
im a
pos
sess
ory
lien
on th
is v
ehic
le fo
r the
am
ount
s in
dica
ted
belo
w p
lus
stor
age
at th
e ra
te in
dica
ted
from
this
dat
e un
til th
e lie
n is
sat
isfie
d.
The
lien
clai
med
aro
se in
the
coun
ty n
amed
abo
ve.
(Ove
r)
In T
he G
ener
al C
ourt
Of J
ustic
eD
istri
ct C
ourt
Div
isio
n-Sm
all C
laim
s
File
No.
Cou
nty
CO
MPL
AIN
T TO
EN
FOR
CE
POSS
ESSO
RY
LIEN
ON
MO
TOR
VEH
ICLE
G.S
. 7A-
211.
1; 2
0-77
(d),
44A-
2(d)
, 44A
-4(b
)(e)
VER
SUS
AOC
-CVM
-203
, Rev
. 3/0
5
2005
Adm
inis
trativ
e O
ffice
of t
he C
ourts
Sign
atur
e O
f Pla
intif
f Or A
ttorn
ey
Nam
e An
d Ad
dres
s O
f Pla
intif
f
Cou
nty
Tele
phon
e N
o.
Nam
e An
d Ad
dres
s O
f Def
enda
nt 1
Cou
nty
Tele
phon
e N
o.
Nam
e An
d Ad
dres
s O
f Def
enda
nt 2
Cou
nty
Tele
phon
e N
o.
Nam
e An
d Ad
dres
s O
f Pla
intif
f's A
ttorn
ey
1.
I rep
air,
serv
ice,
tow
or s
tore
mot
or v
ehic
les
in th
e or
dina
ry c
ours
e of
bus
ines
s.2a
.
I am
an
oper
ator
of a
pla
ce o
f bus
ines
s fo
r gar
agin
g or
par
king
mot
or v
ehic
les
for t
he p
ublic
and
the
mot
or v
ehic
le li
sted
bel
ow h
as re
mai
ned
uncl
aim
ed fo
r at l
east
10
days
.b.
I am
a la
ndow
ner o
n w
hose
pro
perty
the
mot
or v
ehic
le li
sted
bel
ow h
as b
een
aban
done
d fo
r at l
east
30
day
s. T
he p
rope
rty w
as n
ot le
ft by
a te
nant
. [G
.S. 4
2-25
.9(g
); 44
A-2(
e2)]
c. 3.
Tota
l Lie
n C
laim
edTo
Dat
e
The
defe
ndan
ts a
re th
e re
gist
ered
ow
ner o
f the
veh
icle
and
the
know
n se
cure
d pa
rty(ie
s).
$Pe
r Day
Unt
il So
ld)
I gav
e no
tice
of a
n un
clai
med
veh
icle
to th
e D
ivis
ion
of M
otor
Veh
icle
s on
the
date
list
ed a
bove
.
I hav
e gi
ven
notic
e to
the
Nor
th C
arol
ina
Div
isio
n of
Mot
or V
ehic
les
that
a li
en is
ass
erte
d, a
nd s
ale
ispr
opos
ed fo
r the
abo
ve d
escr
ibed
mot
or v
ehic
le.
I dem
and
that
this
Cou
rt de
clar
e th
e lie
n va
lid a
nd e
nfor
ceab
le b
y sa
le a
nd o
rder
that
the
Nor
th
Car
olin
a D
ivis
ion
of M
otor
Veh
icle
s tra
nsfe
r titl
e to
the
pers
on w
ho p
urch
ases
at t
he s
ale
upon
pro
of
that
pro
per n
otic
e of
sal
e ha
s be
en g
iven
.
Stor
age
Cos
t to
Dat
e
Vehi
cle
Ren
tal
Rep
airs
Tow
ing
$ $ $ $
Mak
e/Ye
ar O
f Veh
icle
ID N
umbe
r
Dat
e O
f Pos
sess
ion
Dat
e St
orag
e Be
gan
Dat
e N
otic
e O
f Unc
laim
ed V
ehic
le G
iven
Dat
e 4. 5. 6.
AOC
-CVM
-203
, Sid
e Tw
o, R
ev. 3
/05
20
05 A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
Befo
re fi
ling
this
Com
plai
nt, y
ou m
ust h
ave
filed
cer
tain
form
s w
ith th
e D
ivis
ion
of M
otor
Veh
icle
s. C
onta
ct y
our l
ocal
Div
isio
n of
Mot
or
Vehi
cles
offi
ce.
The
PLAI
NTI
FF m
ust f
ile a
sm
all c
laim
act
ion
in th
e co
unty
whe
re th
e cl
aim
aro
se (i
.e. w
here
the
mot
or v
ehic
le w
as re
paire
d, to
wed
or
stor
ed).
The
PLAI
NTI
FF c
anno
t sue
in s
mal
l cla
ims
cour
t if t
he li
en is
for m
ore
than
$5,
000.
00.
The
regi
ster
ed o
wne
r of t
he v
ehic
le a
nd a
ny s
ecur
ed p
artie
s lis
ted
with
th
e D
ivis
ion
of M
otor
Veh
icle
s m
ust b
e m
ade
defe
ndan
ts in
the
case
. Th
e PL
AIN
TIFF
mus
t sho
w th
e co
mpl
ete
nam
e an
d ad
dres
s of
the
defe
ndan
t to
ensu
re s
ervi
ce o
n th
e de
fend
ant.
If th
ere
are
two
defe
ndan
ts a
nd th
ey re
side
at d
iffer
ent a
ddre
sses
, the
pla
intif
f mus
t in
clud
e bo
th a
ddre
sses
. The
pla
intif
f mus
t det
erm
ine
if th
e de
fend
ant i
s a
corp
orat
ion
and
sue
in th
e co
mpl
ete
corp
orat
e na
me.
If th
e bu
sine
ss is
not
a c
orpo
ratio
n, th
e pl
aint
iff m
ust d
eter
min
e th
e ow
ner's
nam
e an
d su
e hi
m/h
er.
The
PLAI
NTI
FF m
ay s
erve
the
defe
ndan
t(s) b
y m
ailin
g a
copy
of t
he
sum
mon
s an
d co
mpl
aint
by
regi
ster
ed o
r cer
tifie
d m
ail,
retu
rn re
ceip
t re
ques
ted,
add
ress
ed to
the
party
to b
e se
rved
or b
y pa
ying
the
cost
s to
hav
e th
e sh
eriff
ser
ve th
e su
mm
ons
and
com
plai
nt.
If ce
rtifie
d or
re
gist
ered
mai
l is
used
, the
pla
intif
f mus
t file
a s
wor
n st
atem
ent w
ith th
eC
lerk
of S
uper
ior C
ourt
prov
ing
serv
ice
by c
ertif
ied
mai
l and
mus
t at
tach
to th
at s
tate
men
t the
pos
tal r
ecei
pt s
how
ing
that
the
lette
r was
ac
cept
ed.
If th
e na
me
or a
ddre
ss o
f the
veh
icle
ow
ner c
anno
t be
dete
rmin
ed, s
ervi
ce b
y pu
blic
atio
n is
aut
horiz
ed.
In th
at c
ase
plai
ntiff
m
ay w
ant t
o co
nsul
t an
atto
rney
.
1. 2. 3. 4. 5.
INST
RU
CTI
ON
S TO
PLA
INTI
FF O
R D
EFEN
DA
NT
6. 7. 8. 9.
The
PLAI
NTI
FF m
ust p
ay a
dvan
ce c
ourt
cost
s at
the
time
of fi
ling
this
C
ompl
aint
. In
the
even
t tha
t jud
gmen
t is
rend
ered
in fa
vor o
f the
pl
aint
iff, c
ourt
cost
s m
ay b
e ch
arge
d ag
ains
t the
def
enda
nt.
The
DEF
END
ANT
may
file
a w
ritte
n an
swer
, mak
ing
defe
nse
to th
e cl
aim
, in
the
offic
e of
the
Cle
rk o
f Sup
erio
r Cou
rt. T
his
answ
er s
houl
d be
acc
ompa
nied
by
a co
py fo
r the
pla
intif
f and
be
filed
no
late
r tha
n th
e tim
e se
t for
tria
l. T
he fi
ling
of th
e an
swer
DO
ES N
OT
relie
ve th
e de
fend
ant o
f the
nee
d to
app
ear b
efor
e th
e m
agis
trate
to a
sser
t the
de
fend
ant's
def
ense
.
Whe
ther
or n
ot a
n an
swer
is fi
led,
the
PLAI
NTI
FF m
ust a
ppea
r bef
ore
the
mag
istra
te.
The
PLAI
NTI
FF o
r the
DEF
END
ANT
may
app
eal t
he m
agis
trate
's
deci
sion
in th
is c
ase.
To
appe
al, n
otic
e m
ust b
e gi
ven
in o
pen
cour
t w
hen
the
judg
men
t is
rend
ered
, or n
otic
e m
ay b
e gi
ven
in w
ritin
g to
the
Cle
rk o
f Sup
erio
r Cou
rt w
ithin
ten
(10)
day
s af
ter t
he ju
dgm
ent i
s re
nder
ed.
If no
tice
is g
iven
in w
ritin
g, th
e ap
peal
ing
party
mus
t als
o se
rve
writ
ten
notic
e of
app
eal o
n al
l oth
er p
artie
s. T
he a
ppea
ling
party
m
ust P
AY to
the
Cle
rk o
f Sup
erio
r Cou
rt th
e co
sts
of c
ourt
for a
ppea
l w
ithin
twen
ty (2
0) d
ays
afte
r the
judg
men
t is
rend
ered
.
This
form
is s
uppl
ied
in o
rder
to e
xped
ite th
e ha
ndlin
g of
sm
all c
laim
s.
It is
des
igne
d to
cov
er th
e m
ost c
omm
on c
laim
s. Q
uest
ions
abo
ut th
e ad
equa
cy o
f thi
s fo
rm o
r whe
ther
it is
the
appr
opria
te fo
rm to
be
used
sh
ould
be
addr
esse
d to
an
atto
rney
.
Dat
e
Dat
eTOTA
L A
MO
UN
T
Atto
rney
's F
ees
Or O
ther
Dam
ages
(whe
n ap
prop
riate
)
Prin
cipa
l Sum
Of J
udgm
ent
CER
TIFI
CA
TIO
N
This
act
ion
was
trie
d be
fore
the
unde
rsig
ned
on th
e ca
use
stat
ed in
the
com
plai
nt.
The
reco
rd s
how
s th
at th
e de
fend
ant w
as g
iven
pro
per n
otic
e of
the
natu
re o
f the
act
ion
and
the
date
, tim
e an
d lo
catio
n of
tria
l.
It is
OR
DE
RE
D th
at:
I cer
tify
that
this
Jud
gmen
t has
bee
n se
rved
on
each
par
ty n
amed
by
depo
sitin
g a
copy
in a
pos
t-pai
d pr
oper
ly a
ddre
ssed
env
elop
e in
a
post
offi
ce o
r offi
cial
dep
osito
ry u
nder
the
excl
usiv
e ca
re a
nd c
usto
dy o
f the
Uni
ted
Sta
tes
Pos
tal S
ervi
ce.
File
No.
Sig
natu
re O
f Mag
istra
te
(for t
ort c
ases
) the
pla
intif
f rec
over
of t
he d
efen
dant
(s) t
he fo
llow
ing
prin
cipa
l sum
, plu
s in
tere
st a
t the
lega
l rat
e fro
m
the
date
the
actio
n w
as in
stitu
ted
until
judg
men
t is
satis
fied.
(for b
reac
h of
con
tract
cas
es)
the
plai
ntiff
reco
ver o
f the
def
enda
nt(s
) the
follo
win
g pr
inci
pal s
um p
lus
inte
rest
on
the
prin
cipa
l fro
m th
e da
te o
f bre
ach
to th
e da
te o
f jud
gmen
t (1
) at t
he ra
te p
rovi
ded
in th
e co
ntra
ct, a
s fo
und
abov
e; o
r(2
) at t
he le
gal r
ate.
In
addi
tion,
the
prin
cipa
l sha
ll be
ar in
tere
st fr
om th
e da
te o
f jud
gmen
t unt
il th
e ju
dgm
ent i
s sa
tisfie
d (1
) at t
he ra
te p
rovi
ded
in th
e co
ntra
ct, a
s fo
und
abov
e; o
r (2)
at t
he le
gal r
ate.
the
plai
ntiff
reco
ver n
othi
ng o
f the
def
enda
nt(s
) and
that
this
act
ion
be d
ism
isse
d w
ith p
reju
dice
.
the
plai
ntiff
reco
ver p
osse
ssio
n of
the
pers
onal
pro
perty
list
ed b
elow
:th
e pl
aint
iff re
cove
r pos
sess
ion
of th
e pe
rson
al p
rope
rty d
escr
ibed
in th
e co
mpl
aint
.
Oth
er:(
spec
ify)
VER
SUS
FIN
DIN
GS
OR
DER
Cos
ts o
f thi
s ac
tion
are
taxe
d to
the
p
lain
tiff.
d
efen
dant
.
JUD
GM
ENT
IN A
CTI
ON
TO
REC
OVE
RM
ON
EY O
RPE
RSO
NAL
PR
OPE
RTY
$
STA
TE O
F N
OR
TH C
AR
OLI
NA
In T
he G
ener
al C
ourt
Of J
ustic
eD
istri
ct C
ourt
Div
isio
n-S
mal
l Cla
ims
Cou
nty
G.S
. 7A
-210
(2),
7A-2
24
Sig
natu
re O
f Mag
istra
te
$ $Ju
dgm
ent A
nnou
nced
And
Sig
ned
In O
pen
Cou
rt
$
Film
No.
Judg
men
t Doc
ket B
ook
And
Pag
e N
o.
Tele
phon
e N
o.C
ount
y
Cou
nty
Tele
phon
e N
o.
Cou
nty
Nam
e O
f Jud
gmen
t Deb
tor(
s) F
rom
Who
m A
mou
nt R
ecov
ered
Nam
e A
nd A
ddre
ss O
f Pla
intif
f
Tele
phon
e N
o.
Nam
e A
nd A
ddre
ss O
f Def
enda
nt 1
Nam
e A
nd A
ddre
ss O
f Def
enda
nt 2
Nam
e A
nd A
ddre
ss O
f Pla
intif
f's A
ttorn
ey
Nam
e O
f Par
ty A
nnou
ncin
g A
ppea
l In
Ope
n C
ourt
Pre
-judg
men
t Int
eres
t Not
Incl
uded
In P
rinci
pal
NO
TE: T
o be
use
d w
hen
mag
istra
te d
oes
not a
nnou
nce
and
sign
this
Jud
gmen
t in
open
cou
rt at
the
conc
lusi
on o
f the
tria
l.
AO
C-C
VM
-400
, Rev
. 2/1
2©
201
2 A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
Oth
er:
the
cont
ract
pro
vide
s fo
r pre
-judg
men
t int
eres
t on
dam
ages
for b
reac
h at
the
rate
of
% a
nd/o
r po
st-ju
dgm
ent i
nter
est a
t the
rate
of
%.
the
cont
ract
doe
s no
t pro
vide
a s
peci
fic p
re-ju
dgm
ent i
nter
est r
ate.
the
cont
ract
doe
s no
t pro
vide
a s
peci
fic p
ost-j
udgm
ent i
nter
est r
ate.
the
plai
ntiff
has
pro
ved
the
case
by
the
grea
ter w
eigh
t of t
he e
vide
nce.
the
plai
ntiff
has
faile
d to
pro
ve th
e ca
se b
y th
e gr
eate
r wei
ght o
f the
evi
denc
e.th
e de
fend
ant(s
)
w
as
w
as n
ot
pres
ent a
t tria
l. th
e ca
se in
volv
es a
bre
ach
of c
ontra
ct a
nd th
e da
te o
f bre
ach
is:
.
The
Cou
rt fin
ds th
at:
Forms - Page 13
Forms - Page 14
the
defe
ndan
t(s)
was
w
as n
ot
pres
ent.
T
he d
efen
dant
was
ser
ved
by p
ostin
gs.
ther
e is
no
disp
ute
as to
the
amou
nt o
f ren
t in
arre
ars,
and
the
amou
nt is
$
.
ther
e is
an
actu
al d
ispu
te a
s to
the
amou
nt o
f ren
t in
arre
ars.
The
def
enda
nt(s
) cla
ims
the
amou
ntof
rent
in a
rrea
rs is
$
, an
d th
is a
mou
nt is
the
undi
sput
ed a
mou
nt o
f ren
t in
arr
ears
.
the
plai
ntiff
has
pro
ved
the
case
by
the
grea
ter w
eigh
t of t
he e
vide
nce.
the
plai
ntiff
has
faile
d to
pro
ve th
e ca
se b
y th
e gr
eate
r wei
ght o
f the
evi
denc
e.th
e pl
aint
iff re
ques
ted
and
was
ent
itled
to a
judg
men
t for
pos
sess
ion
base
d on
the
plea
ding
.
The
Cou
rt fin
ds th
at:
File
No.
$
the
defe
ndan
t(s) b
e re
mov
ed fr
om a
nd th
e pl
aint
iff b
e pu
t in
poss
essi
on o
f the
pre
mis
es d
escr
ibed
in th
eco
mpl
aint
.th
is a
ctio
n be
dis
mis
sed
with
pre
judi
ce.
this
act
ion
be d
ism
isse
d w
ith p
reju
dice
bec
ause
the
defe
ndan
t ten
dere
d th
e re
nt d
ue a
nd th
e co
urt c
osts
of th
is a
ctio
n.th
e pl
aint
iff re
cove
r ren
t of t
he d
efen
dant
(s) i
n th
e am
ount
and
at t
he ra
te li
sted
bel
ow, p
lus
othe
r da
mag
es in
the
amou
nt in
dica
ted.
The
pla
intif
f is
also
ent
itled
to in
tere
st o
n th
e to
tal p
rinci
pal s
um fr
om
this
dat
e un
til th
e ju
dgm
ent i
s pa
id.
othe
r: (s
peci
fy)
1. 2. 3. 4. 5. 6.co
sts
of th
is a
ctio
n ar
e ta
xed
to th
e
plai
ntiff
.
defe
ndan
t.
It is
OR
DER
ED th
at:
a. b.
2. 3.
othe
r:4.
a. b. c.
Judg
men
t Ann
ounc
ed A
nd S
igne
d In
Ope
n C
ourt
Mo.
Wk.
STA
TE O
F N
OR
TH C
AR
OLI
NA
Nam
e A
nd A
ddre
ss O
f Pla
intif
f
Am
ount
Of O
ther
Dam
ages
$
Am
t. O
f Ren
t In
Arr
ears
(Ow
ed T
o D
ate)
CER
TIFI
CA
TIO
N
OR
DER
1.JU
DG
MEN
TIN
AC
TIO
N F
OR
SUM
MA
RY
EJEC
TMEN
T
$S
igna
ture
Of M
agis
trate
This
act
ion
was
trie
d be
fore
the
unde
rsig
ned
on th
e ca
use
stat
ed in
the
com
plai
nt. T
he re
cord
sho
ws
that
the
defe
ndan
t w
as g
iven
pro
per n
otic
e of
the
natu
re o
f the
act
ion
and
the
date
, tim
e an
d lo
catio
n of
tria
l.
In T
he G
ener
al C
ourt
Of J
ustic
eD
istri
ct C
ourt
Div
isio
n-Sm
all C
laim
sC
ount
y
G.S
. 7A
-210
(2),
7A-2
24; 4
2-30
VER
SUS
FIN
DIN
GS
(NO
TE: T
o be
use
d w
hen
mag
istra
te d
oes
not a
nnou
nce
and
sign
this
Jud
gmen
t in
open
cou
rt at
the
conc
lusi
on o
f the
tria
l.)I c
ertif
y th
at th
is J
udgm
ent h
as b
een
serv
ed o
n ea
ch p
arty
nam
ed b
y de
posi
ting
a co
py in
a p
ost-p
aid
prop
erly
add
ress
ed e
nvel
ope
in a
po
st o
ffice
or o
ffici
al d
epos
itory
und
er th
e ex
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at:
Nam
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Ope
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Forms - Page 18
(Over)
County Where Property Located
Street Address Of Residence
5.
I am unmarried and 65 years of age or older and this property was previously owned by me as a tenant by entireties or as a joint tenant with rights of survivorship and the former co-owner of the property is deceased.
Legal Description (Attach a copy of your deed or other instrument of conveyance or describe property in as much detail as possible. Attach additional sheets if necessary.)
Name(s) Of Owner(s) Of Record Of Residence
Township No. By Which Tax Assessor Identifies Property
I wish to claim as exempt (keep from being taken) my interest in the following real or personal property, or in a cooperative that ownsproperty, that I use as a residence. I also wish to claim my interest in the following burial plots for myself or my dependents. I understand that my total interest claimed in the residence and burial plots may not exceed $35,000.00 except that if I am unmarried and am 65 years of age or older, I am entitled to claim a total exemption in the residence and burial plots not to exceed$60,000.00 so long as the property was previously owned by me as a tenant by the entireties or as a joint tenant with rights of survivorship, and the former co-owner of the property is deceased.
attorney. THERE ARE CERTAIN EXEMPTIONS UNDER STATE AND FEDERAL LAW THAT YOU ARE ENTITLED TO CLAIM IN ADDITION TO THE EXEMPTIONS LISTED BELOW. These exemptions may include social security, unemployment, and workers' compensation benefits and earnings
Name Of Judgment Debtor (Defendant)
Name Of Judgment Creditor (Plaintiff)
VERSUS
Date Judgment Filed
District Superior Court DivisionIn The General Court Of Justice
b.
a.
1.
3.
4.
2.
I am a citizen and resident of
My current address is .
The following persons are dependent on me for support:
I am married to
I am not married.
.
.
I, the undersigned, move to set aside the property claimed below as exempt.
Estimated Value Of Residence (What You Think You Could Sell It For)
$
Judgment Docket Book And Page No.
County
MOTION TO CLAIM EXEMPT PROPERTY
(STATUTORY EXEMPTIONS)(Use if judgment filed after 1/1/06)
G.S. 1C-1603(c)
(TYPE OR PRINT IN BLACK INK) Abstract No.File No.
STATE OF NORTH CAROLINA
© 2011 Administrative Office of the Courts
Name(s) Of Person(s) Dependent On Me Age
for your personal services rendered within the last 60 days. There is available to you a prompt procedure for challenging an attachment or levy on your property.
NOTE TO JUDGMENT DEBTOR: The Clerk of Superior Court cannot fill out this form for you. If you need assistance, you should talk with an
You must pay $20 to the Clerk of Superior Court to file this document. Payment can be made in cash, cashier's check or money order. If you cannot afford to pay this fee you can apply to the Clerk to file as an indigent by completing form "PETITION TO SUE/APPEAL/FILE MOTIONS" AOC-G-106.
AOC-CV-415, Page 1 of 4, Rev. 8/11
Real Property Claimed
Fair Market Value (What You Could Sell It For)
Amount Of Liens (Amount Owed)
Name Of Title Owner Of RecordMake And Model Year
Name Of Lienholder(s) Of Record (Person(s) To Whom Money Is Owed)
Value Of Debtor's (Defendant's) Interest (Fair Market Value Less Amount Owed)
$
$
$(This item is to claim any other property you own that you wish to exempt.) I wish to claim the following property as exempt because I claimed residential real or personal property as exempt that is worth less than $35,000.00, or I made no claim for a residential exemption under section (5) above. I understand that I am entitled to an exemption of up to $5,000.00 on any property only if I made no claim under section (5) or a claim that was less than $35,000.00 under Section (5). I understand that I am entitledto claim any unused amount that I was permitted to take under section (5) up to a maximum of $5,000.00 in any property.
$35,000 under section (5), no claim allowed here.) I further understand that the amount of my claim under this section is after the deduction from the value of this property of the amount of any valid lien or security interests and that tangible personal property purchased within ninety (90) days of this proceeding may not be exempt.
8.
Amount Of Lien(s) And Name(s) And Address(es) Of Lienholder(s):(How much money is owed on the property and to whom) Current Amount Owed
$
$
$
$
$
$
$
$
$
Item Of Property
Fair Market Value
(What You Could Sell It For)
Amount Of Lien Or Security
Interest(Amount Owed On
Property)Name(s) Of Lienholder(s)
(To Whom Money Is Owed)
Value Of Debtor's (Defendant's) Interest(Fair Market Value Less
Amount Owed)
I wish to claim the following personal property consisting of household furnishings, household goods, wearing apparel, appliances, books, animals, crops or musical instruments as exempt from the claims of my creditors (in other words, keep them from being taken from me). These items of personal property are held primarily for my personal, family or household use.
6.
I understand that I am entitled to personal property worth the sum of $5.000.00. I understand I am also entitled to an additional $1,000.00 for each person dependent upon me for support, but not to exceed $4,000.00 for dependents. I further understand that Iam entitled to this amount after deducting from the value of the property the amount of any valid lien or security interest. Property purchased within ninety (90) days of this proceeding may not be exempt. (Some examples of household goods would be TV, appliances,furniture, clothing, radios, record players.)
I wish to claim my interest in the following motor vehicle as exempt from the claims of my creditors. I understand that I am entitled to my interest in one motor vehicle worth the sum of $3,500.00 after deduction of any valid liens or security interests. I understand that a motor vehicle purchased within ninety (90) days of this proceeding may not be exempt.
7.
Item Of Personal Property Claimed
Fair Market Value
Amount Of Lien(s) Name(s) Of Lienholder(s)
Value Of Debtor's (Defendant's) Interest
(I understand that if I wish to claim more than one parcel, I must attach additional pages setting forth the following information for each parcel claimed as exempt.)
$
$
$
$
$
$
$
$
Estimated Value Of Property (What You Could Sell It For)
$Street Address
Description (Attach a copy of your deed or other instrument of conveyance or describe the property in as much detail as possible.)
No. By Which Tax Assessor Identifies PropertyTownshipCounty Where Property Located
$
$
$
$
Value Of Burial Plots ClaimedLocation Of Burial Plots Claimed
$
$
$
© 2011 Administrative Office of the CourtsAOC-CV-415, Page 2 of 4, Rev. 8/11
(Examples: If you claim $34,000 under section (5), $1,000 allowed here; if you claim $30,000 under section (5), $5,000 allowed here; if you claim
File No.VERSUS
Judgment Docket Book And Page No.
$
$
$
Item Estimated Value
(What You Could Sell It For) What Business Or Trade Used In
Date Judgment Filed
Type Of Account
Type Of Account Account NumberName Of Custodian Of IRA Account
Account NumberName Of Custodian Of IRA Account
13. I wish to claim my individual retirement accounts, including Roth accounts, and individual retirement annuities (IRA's) that are listed below.
14. I wish to claim the following funds I hold in a college savings plan that is qualified under section 529 of the Internal Revenue Code,not to exceed $25,000.00. I understand that the plan must be for my child and must actually be used for the child's college expenses. I understand that I may not exempt any funds I placed in this account within the preceding 12 months, except to the extent that any contributions were made in the ordinary course of my financial affairs and were consistent with my past pattern of contributions.
College Savings Plan Account Number Value Name(s) Of Child(ren) Beneficiaries
$
$
Location/Source Of Compensation
Amount Of Compensation
I wish to claim the following life insurance policies whose sole beneficiaries are my spouse and/or my children as exempt.
$
(Over)
Current Amount Owed
$Name And Address Of Lienholder
(Attach additional sheets for more lienholders.)
Item Purpose
I wish to claim the following implements, professional books, or tools (not to exceed $2,000.00), of my trade or the trade of my dependent. I understand such property purchased within ninety (90) days of this proceeding may not be exempt.
I wish to claim the following items of health care aid (wheelchairs, hearing aids, etc.) necessary for myself my dependents.9.
10.
Current Amount OwedName And Address Of Lienholder
Name Of Insurer Policy Number Beneficiary(ies)
11.
I wish to claim as exempt the following compensation that I received or to which I am entitled for the personal injury of myself or a person upon whom I was dependent for support, including compensation from a private disability policy or an annuity, or compensation that I received for the death of a person upon whom I was dependent for support. I understand that this compensation is not exempt from claims for funeral, legal, medical, dental, hospital or health care charges related to the accident or injury that resulted in the payment of the compensation to me. (Add additional sheets if more than one amount of compensation.)
12.
$
Method Of Payment Lump Sum Or Installments (If Installments, State Amount, Frequency And Duration Of Payments)
Name Of Judgment Creditor (Plaintiff)
Abstract No.
© 2011 Administrative Office of the CourtsAOC-CV-415, Page 3 of 4, Rev. 8/11
Date
A copy of this Motion was served on the judgment creditor (plaintiff) by:personallyattorney.judgment creditor (plaintiff) at the address shown on the notice of rights served on me. a post-paid properly addressed envelope in a post office, addressed to the judgment creditor's (plaintiff's) attorney at the following address:
Signature Of Judgment Debtor/Attorney For Debtor (Defendant)
I certify that the above statements are true.18.
Date
Signature Of Judgment Debtor/Attorney For Debtor (Defendant)
Address And Phone Number Of Attorney For Debtor (Defendant)
19. delivering a copy to the judgment creditor (plaintiff)delivering a copy to , the judgment creditor's
depositing a copy of this Motion in a post-paid properly addressed envelope in a post office, addressed to the depositing a copy of this motion in
Item Location Estimated Value
$
$
$
The following is a complete listing of my property which I do NOT claim as exempt.17.
16. I wish to claim as exempt any alimony, support, separate maintenance, or child support payments or funds that I have received or that I am entitled to receive. I understand that these payments are exempt only to the extent that they are reasonably necessary for my support or for the support of a person dependent on me for support.
Type Of Support Person Paying Support Amount Of Support Location Of Funds
15. I wish to claim the following retirement benefits to which I am entitled under the retirement plans of other states and governmental units of other states. I understand that these benefits are exempt only to the extent these benefits are exempt under the law of the state or governmental unit under which the benefit plan was established.
State/Governmental Unit Name of Retirement Plan Identifying Number
© 2011 Administrative Office of the CourtsAOC-CV-415, Page 4 of 4, Rev. 8/11
STATE OF NORTH CAROLINAFile No.
Film No.
PM AM
DISMISSAL Without PrejudiceWith Prejudice
The plaintiff elected not to prosecute this action and has moved for dismissal.
Neither the plaintiff, nor the defendant appeared on the scheduled trial date.
The plaintiff failed to appear on the scheduled trial date; the defendant did appear on that date and has moved to dismiss this action.
Other:
This action is dismissed for the following reason:
DISCONTINUANCE [G.S. 1A-1, Rule 4(e)]
The defendant has never been served in this action, and more than ninety (90) days have elapsed since the last summons was issued.
BANKRUPTCY
CONTINUANCE
Plaintiff
Defendant
Judge or Magistrate
Other: (specify)
The trial of this action is continued to the following date and time on motion of the
It is ordered that this action be removed from the active calendar and placed on inactive status because a petition for bankruptcy has been filed staying this proceeding. This action may be reinstated if the claim is not resolved in the U.S. Bankruptcy or District Courts.
Signature
Time Of New Trial
In The General Court Of Justice
County
VERSUS ORDER
AOC-G-108, Rev. 11/02 2002 Administrative Office of the Courts
Name Of Plaintiff/Petitioner
Name Of Defendant/Respondent
Judge
Assistant CSC
Magistrate
Clerk Of Superior Court
Date
District Superior Court Division Small Claims
Date Of New Trial Location Of New Trial
Forms - Page 24