Fill and Sign the Of Reinstatement and Form

STATE OF NORTH CAROLINA Court File No. Deputy CSC Clerk Of Superior Court I hereby request reinstatement of the licensing pri vileges listed below, which were revoked based on m y failure to pay child support. I am no longer delinquent in paying court-ordered child support. Hunting Fishing Trapping Occupational, Business or Professional Occupational, Business or Professional Occupational, Business or Professional Driving Motor Vehicle Registration (IV-D only) Deputy CSC Clerk Of Superior CourtAssistant CSC IV-D Agency Assistant CSC IV-D Agency Deputy CSC Clerk Of Superior Court Assistant CSC IV-D Agency Date Of Birth Race Sex IV-D Case No. AOC-CV-653, Rev. 3/09 © 2009 Administrative Office of the Courts County In The General Court Of Justice District Court Division REQUEST FOR REINSTATEMENT OF LICENSING PRIVILEGES N. C. W ildlife Resources Commission, 1707 Mail Servic e Center, Raleigh, NC 27699-1707 N. C. W ildlife Resources Commission, 1707 Mail Servic e Center, Raleigh, NC 27699-1707 N. C. W ildlife Resources Commission, 1707 Mail Servic e Center, Raleigh, NC 27699-1707 N. C. Division of Motor Vehicles, 1320 Mail Service Center, Raleigh, NC 27699-1320 N. C. Division of Motor Vehicles, 1320 Mail Service C enter, Raleigh, NC 27699-1320 Name And Address Of Issuing Agency Type(s) Of License License Number(s) CERTIFICATE OF MAILING CERTIFICATION CERTIFICATE AUTHORIZING REINSTATEMENT OF LICENSING PRIVILEGES At the request of the obligor, a copy of this Order was mailed by first class mail on the date shown b elow to the licensing agency(ies) shown above. I certify that this is a true copy of an original o rder on file in the office of the Clerk of Superior Court. I hereby certify pursuant to G.S. 50-13.12(c) or G. S. 110-142(d) that the above-named obligor is no lo nger delinquent in child support and is eligible for reinstatement of any licensing privileges which were revoked on the basis of his/her failure to pay child support. Signature Of Obligor Signature Signature Signature Date Date Date Of Certificate Date Of Mailing Date Of Certificate (TYPE OR PRINT IN BLACK INK) VERSUS REQUEST FOR CERTIFICATION OF REINSTATEMENT AND CERTIFICATE AUTHORIZING REINSTATEMENT OF LICENSING PRIVILEGES G.S. 50-13.12; 110-142.2 Name Of Plaintiff Name Of Defendant Name And Address Of Obligor