STATE OF NORTH CAROLINA                                                                                                                File No.
_________________________________________
__________________ County                                                                                                  In the General Court of Justice
                                                                                                                           0 District 0 Superior Court Division
Name of Plaintiff
_________________________________________________
Address                                                                                                                           CIVIL SUMMONS
_________________________________________________                                                       O ALIAS AND PLURIES SUMMONS (ASSESS FEE)
City, State, Zip                                                                                                                                          G.S. 1A-1, RULES 3, 4
__________________________________________________                                                          _____________________________________________
                           VERSUS                                                                           Date Original Summons Issued
Name of Defendant(s)                                                                          _____________________________________________
__________________________________________________                                                          Date(s) Subsequent Summons(es) Issued
                                                                                                            ___________________________________________________
TO EACH OF THE DEFENDANT(S) NAMED BELOW:
Name and Address of Defendant 1                                                                             Name and Address of Defendant 2
A Civil Action Has Been Commenced Against You!
You are notified to appear and answer the complaint of the plaintiff as follows:
1. Serve a copy of your written answer to the complaint upon the plaintiff or plaintiff’s attorney within thirty (30) days after you have been
served. You may serve your answer by delivering a copy to the plaintiff or by mailing it to the plaintiff’s last known address, and
2. File the original of the written answer with the Clerk of Superior Court of the county named above.
If you fail to answer the complaint, the plaintiff will apply to the Court for the relief demanded in the complaint.
Name And Address of Plaintiff’s Attorney (If None, Address of Plaintiff)                                    Date Issued                Time                         O AM
                                                                                                                                                                    O PM
                                                                                                            Signature
                                                                                                            ________________________________________________________
                                                                                                                        O Deputy CSC   O Assistant CSC O Clerk of Superior
Court
ENDORSEMENT (ASSESS FEE)
This summons was originally issued on the date indicated                                                    Date of Endorsement        Time                         O AM
and returned not served. At the request of the plaintiff, the                                                                                                       O PM
time within which this Summons must be served is extended                                                   ___________________________________________
sixty (60) days.                                                                                            O Deputy CSC    O Assistant CSC   O Clerk of Superior Court
NOTE TO PARTIES: Many counties have MANDATORY ARBITRATION programs which most cases where the amount in controversy is $15,000 or less
are heard by an arbitrator before a trial. The parties will be notified if this case is assigned for mandatory arbitration, and, if so, what procedure is to be followed.