Fill and Sign the Application and Order Extending Time to File Complaint Form

Assistant Clerk Of Superior Court Clerk Of Superior Court STATE OF NORTH CAROLINA File No. Signature Signature Applicant Attorney For Applicant ORDER APPLICATION (Over) The Court states that the nature and purpose of this action are as set forth above. Therefore, it is ORDERED that permission is granted to the applicant to file a complaint in this action up to and including the date shown below. APPLICATION AND ORDER EXTENDING TIME TO FILE COMPLAINT County VERSUS G.S. 1A-1, Rule 3 © 2011 Administrative Office of the Courts In The General Court Of Justice District Superior Court Division The undersigned requests permission to file a complaint in this action within twenty (20) days of any order granting this Application, as provided in Rule 3 of the Rules of Civil Procedure. The nature and purpose of the action are: NOTE: (Date must be within 20 days of date of Order.) Under Rule 3 of the Rules of Civil Procedure, upon entry of this Order, a summons shall be issued and the summons and a copy of this Order must be served in accordance with the provisions of Rule 4. A complaint must be filed in this action within the period provided above and that complaint must be served in accordance with the provisions of Rule 4 or by registered mail if the plaintiff so elects. If a complaint is not filed within the above period, the action shall abate. Name Of Plaintiff Name Of Defendant Date Date Of Order File Complaint On Or Before Name And Purpose Of The Action AOC-CV-101, Rev. 7/11 The undersigned Resident Superior Court Judge of the county named above has has not determined that good cause exists for granting the above motion and that the ends of justice will be served by an extension. STATE OF NORTH CAROLINA File No. the motion is allowed and the statute of limitations applicable to the complainant(s) cause of action is extended to and including the date shown below. the motion is denied. It is ORDERED that: The Court finds the facts listed in the motion and adopts those as a basis for determining good cause. Complainant Attorney ORDER MOTION © 2011 Administrative Office of the Courts MOTION AND ORDER EXTENDING STATUTE OF LIMITATIONS IN MEDICAL MALPRACTICE ACTION County VERSUS G.S. 1A-1, Rule 9(j) In The General Court Of Justice District Superior Court Division The complainant(s) named above intends to commence a medical malpractice action against the prospective defendant(s) named above on a cause of action that arose in the county named above, and, based on the facts listed below, needs additional time to comply with Rule 9(j) of the North Carolina Rules of Civil Procedure. The applicable statute of limitations has not yet expired. The complainant(s) moves to extend the statute of limitations for a period not to exceed one hundred twenty (120) days. Signature Signature Of Resident Superior Court Judge NOTE: Rule 9(j) of the Rules of Civil Procedure provides, "Upon motion by the complainant prior to the expiration of the applicable statute of limitations,a resident judge of the superior court for a judicial district in which venue for the cause of action is appropriate under G.S. 1-82 or, if no resident judge for that judicial district is physically present in that judicial district, otherwise available, or able or willing to consider the motion, then any presiding judge of the superior court for that judicial district may allow a motion to extend the statute of limitations for a period not to exceed 120days to file a complaint in a medical malpractice action in order to comply with this Rule, upon a determination that good cause exists for the granting of the motion and that the ends of justice would be served by an extension." Name Of Complainant(s) Name Of Prospective Defendant(s) Date Statute Of Limitations Extended To: Name Of Resident Superior Court Judge (Type Or Print) Date Of Order (Specify basis for motion to enable judge to determine good cause exists.) AOC-CV-101, Side Two, Rev. 7/11