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(Over) STATE OF NORTH CAROLINA File No. Name Of Juvenile Deputy CSC AOC-J-121, New 7/99 © 1999 Administrative Office of the Courts SUMMONS AND NOTICE OF HEARING ON PETITION AM PM for a hearing to determine whether the attached ex parte order should be continued or a different order entered. for a hearing on the attached petition. Parent Other (specify) Parent Other (specify) You are SUMMONED to appear on the date and at the time and location set forth below: A petition has been filed alleging that the respondent(s) named above is/are obstructing and/or interf ering with an investigation of a report that the juvenile named a bove is abused, neglected, or dependent, or has die d as a result of suspected maltreatment. Date Of Hearing Location Of Hearing Time Of Hearing SUMMONS AND NOTICE OF HEARING ON PETITION AM PM for a hearing to determine whether the attached ex parte order should be continued or a different order entered. for a hearing on the attached petition. Parent Other (specify) Other (specify) You are SUMMONED to appear on the date and at the time and location set forth below: A petition has been filed alleging that the respondent(s) named above is/are obstructing and/or interf ering with an investigation of a report that the juvenile named a bove is abused, neglected, or dependent, or has die d as a result of suspected maltreatment. Date Of Hearing Location Of Hearing Time Of Hearing Assistant CSC Clerk Of Superior Court Signature Date Parent Parent Other (specify) Other (specify) Name And Address Of Other Person To Be Served Name And Address Of Other Person To Be Served JUVENILE SUMMONS AND NOTICE OF HEARING (OBSTRUCTION OF OR INTERFERENCE WITH JUVENILE INVESTIGATION) County G.S. 7B-303 In The General Court Of Justice District Court Division IN THE MATTER OF To Each Of The Person(s) Named Below: Name And Address Of Respondent 1 Name And Address Of Respondent 2 RESPONDENT 2 This person WAS NOT served for the following reason: By leaving a copy of the summons and petition at the dwelling house or usual place of abode of the person named above with a person of suitable age and discretion then residing therein. By delivering to the person named above a copy of t he summons and petition. This person WAS NOT served for the following reason : By leaving a copy of the summons and petition at the dwelling house or usual place of abode of the person named above with a person of suitable age and discretion then residing therein. By delivering to the person named above a copy of t he summons and petition. This person WAS NOT served for the following reason : This person WAS NOT served for the following reason: By leaving a copy of the summons and petition at the dwelling house or usual place of abode of the person named above with a person of suitable age and discretion then residing therein. By delivering to the person named above a copy of t he summons and petition. By leaving a copy of the summons and petition at the dwelling house or usual place of abode of the person named above with a person of suitable age and discretion then residing therein. By delivering to the person named above a copy of t he summons and petition. AOC-J-121, Side Two, New 7/99 © 1999 Administrative Office of the Courts I certify that this Summons and a copy of the petition were received and served as follows: RETURN OF SERVICE Name Of Person To Be Served Date Served Name Of Person To Be Served Date Served Name And Address Of Person With Whom Copies Left County Date Of Return Name Of Sheriff Date Received Deputy Sheriff Making Return RESPONDENT 1 OTHER PERSON TO BE SERVED 1 Name Of Person To Be Served Date Served Name And Address Of Person With Whom Copies Left OTHER PERSON TO BE SERVED 2 Name Of Person To Be Served Date Served Name And Address Of Person With Whom Copies Left Name And Address Of Person With Whom Copies Left