Fill and Sign the Emancipation Proceeding Form

The petitioner named above has petitioned the court for a judicial decree of emancipation. Parent Guardian Custodian Parent Guardian Custodian AM PM AM PM AM PM Deputy CSC Assistant CSC Clerk Of Superior Court NOTICE OF HEARING ENDORSEMENT This Summons was originally issued on the date indicated above and returned not served. At the request of the petitioner, the time within which this Summons must be served is extended thirty (30) days. Place Of Hearing SUMMONS AND NOTICE OF HEARING ON PETITION If you fail to answer the petition, the petitioner will apply to the Court for a decree of emancipation. 1. 2. File the original of your written answer with the Clerk of Superior Court of the county named above within thirty (30) days after you are served with this summons and petition. Serve a copy of your written answer to the petition on the petitioner or petitioner's attorney within thirty (30) days after you have been served. You may serve your answer by delivering a copy to the petitioner (or petitioner's attorney) or by mailing it to the petitioner's last known address (or the petitioner's attorney, if any, at address given above). Signature Signature Date Of Hearing Time Of Hearing Date Issued Time Date Of Endorsement Time To Each Of The Respondent(s) Named Above: Deputy CSC Assistant CSC Clerk Of Superior Court You are SUMMONED to appear on the date and at the time and place set forth below for a hearing on the attached petition. You are notified to answer the petition of the petitioner as follows: (Over) AOC-J-910M, Rev. 12/09 © 2009 Administrative Office of the Courts Alias and Pluries Summons G.S. 7B-3502 VERSUS Name And Address Of Respondent 1 Name And Address Of Respondent 2 Date Last Summons Issued JUVENILE SUMMONS EMANCIPATION PROCEEDING County In The General Court Of Justice District Court Division Name And Address Of Petitioner Name And Address Of Petitioner's Attorney File No. STATE OF NORTH CAROLINA AOC-J-910M, Side Two, Rev. 12/09 © 2009 Administrative Office of the Courts Respondent WAS NOT served for the following reason: Other manner of service (specify) 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. Respondent WAS NOT served for the following reason: Other manner of service (specify) 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. RETURN OF SERVICE I certify that this Summons and a copy of the petition were received and served as follows: RESPONDENT 1 RESPONDENT 2 Date Served Name Of Respondent 1 Name Of Person With Whom Copies Left Date Served Name Of Respondent 2 Name Of Person With Whom Copies Left Date Received Date Of Return Name Of Sheriff County Deputy Sheriff Making Return