Fill and Sign the File No State of North Carolina in the General Court of Justice Form

The Court has been furnis hed a pr operly executed form DL- 123 an d is satisfied that the def endant is fi nancially res ponsible. The def endant has executed form DL- 123A and is not r equired to furnish proof of fi nancial res ponsibility. File No. STATE OF NORTH CAROLINA Signature Of Defendant Deputy CSC Assistant CSC Clerk Of Superior Court 3. 4. is s upp orting existing dependent(s). must have a drivers license to be gainfully employed. has an existing dependent who requires serious medical treatment and the def endant is the only person able to provide transportation to the dependent to the health care facility where the dependent can receive the medical treatment. a. b. c. At the time of the forfeiture of the def endant’s licensing privileges, the defendant held either a valid drivers license or a drivers license that had bee n expired less than one year. The def endant: 1. 2. The def endant has been convicted of a felony, and the def endant's drivers license has been forfeited, purs uant to Judicial Findings As To Forfeiture Of Licensing Privil eges entered in and m ade a part of the record in this case. U pon ap plication of the def endant for a limited driving privil ege, the Court finds that FINDINGS ORDER It is ORDERED that the def endant be allowed a limited driving privil ege to operate a non-commercial motor vehicle under the following c on ditions, which the Court has determi ned will authorize essential driving related to the purposes listed in finding number 2 above, and und er no other circumstances. Geographical Restriction Additi onal Restrictions: Other: Corrective Lenses 45 M.P.H. Only Daylight Only Driving Hours Allowed Type Of Vehicle This Limited Driving Privil ege authorizes the def endant to drive only if the def endant's license is revoked solely for a felony conviction and was ordered forfeited, and only for the duration of that revocation or for the period shown below, whichever is shorter. This Limited Driving Privil ege is subject to such further orders as the Court may deem necessary and pr oper. It is c onditi one d upo n the maint enance of fi nancial res ponsibility. Signature Of Judge Date Of Order Effective From To Name Of Judge (Type Or Print) Signature And Seal NOTICE/ ACKNOWLEDGMENT OF RECEIPT CERTIFICATION I have received a copy of this Limited Driving Priv ileg e which co ntains the restrictions on my driving privileg e. I u ndersta nd that this is my limited license to drive; that I must ke ep it in my possession during the period of revocation; that if my drivers license is revoked for any other reason, this Limited Driving Priv ileg e is invalid. Any driving not related to the purposes(s) checked above is unlawful even thoug h don e at times a nd upo n routes that may be authorized; a nd that a violation of any restriction imposed in connection with this Limited Driving Privilege constitutes the offense of driving while license revoked under G.S. 20-28. This limited privilege do es NOT authorize the op eration of a commercial motor vehicle. I certify that this is a true and complete copy of the original on file in this case. Date Date Race Sex Height Weight Date Of Birth Hair Color Eye Color Date Of Conviction Offense For Which Defendant Was Convicted Drivers License No. And State Materials opposite unmarked squares is to be disregarded as surplusage. Original-File Certified Copy-Defendant Copy-DMV Cou nty STATE VERSUS LIMITED DRIVING PRIVILEGE FELONY CONVIC TION G.S. 15A-1331.1; 20-15.1, 20-179.3 In The G eneral Court Of Justice District S up erior Court Division Name And Address Of Defendant AOC-CR-318, Rev. 10/15 © 201 5 Administrative Office of the Courts