Fill and Sign the Alias and Pluries Summons Assess Fee Form

File No. Plaintiff(s)Date(s) Subsequent Summons(es) Issued Name And Address Of Defendant 2 Telephone No. Of Defendant 2 Name And Address Of Defendant 1 Telephone No. Of Defendant 1 STATE OF NORTH CAROLINA County In The General Court Of Justice District Court Division - Small Claims TO TO (Over) MAGISTRATE SUMMONS ALIAS AND PLURIES SUMMONS (ASSESS FEE) Defendant(s)Date Original Summons Issued G.S. 1A-1, Rule 4; 7A-217, -232 VERSUS A Small Claim Action Has Been Commenced Against You! 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 before the 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. Location Of Court Name And Address Of Plaintiff Or Plaintiff’s Attorney Signature Date Issued Deputy CSC Assistant CSC Clerk Of Superior Court Date Of Trial Time Of Trial AM PM AOC-CVM-100, Rev. 8/17 © 2017 Administrative Of�ce of the Courts I certify that this summons and a copy of the complaint were received and served as follows: RETURN OF SERVICE By delivering to the defendant named above a copy of the summons and complaint. By leaving a copy of the 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. By delivering to the defendant named above a copy of the summons and complaint. By leaving a copy of the 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. Date Served Date Served Name Of DefendantName Of Defendant Name And Address Of Person With Whom Copy Left (if corporation, give title of person copy left with) Name And Address Of Person With Whom Copy Left (if corporation, give title of person copy left with) Other manner of service (specify) Other manner of service (specify) Defendant WAS NOT served for the following reason: Defendant WAS NOT served for the following reason: DEFENDANT 1 DEFENDANT 2 Time Served AM PM Time Served AM PM Service was made by mailing by �rst 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: Name(s) Of The Defendant(s) Served By Posting Date Served Address Of Premises Where Posted Signature Of Deputy Sheriff Making Return Service Fee Date Received Date Of Return County Of Deputy Sheriff Making Return Name Of Deputy Sheriff Making Return (type or print) $ FOR USE IN SUMMARY EJECTMENT CASES ONLY: AOC-CVM-100, Side Two, Rev. 8/17 © 2017 Administrative Of�ce of the Courts