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File No. ORDER AND NOTICE THAT JUVENILE NOT BE LICENSED TO OPERATE MOTOR VEHICLE STATE OF NORTH CAROLINA County In The General Court Of Justice District Court Division Name And Address Of Juvenile IN THE MATTER OF The undersigned clerk of court hereby notifies the Division of Motor Vehicles of the Order appearing above. When the Order was entered, the juvenile: 1. did did not have a learner’s permit, temporary driving certificate, or drivers license in North Carolina or any other state. 2. The juvenile surrendered his/her North Carolina learner’s permit, temporary driving certificate, or drivers license to the Court. Ending Date Signature Of District Court Judge Race Sex Juvenile’s Date Of Birth Date Of Hearing Age Beginning Date Juvenile’s Permit Or License No. State Date Permit/License Issued G.S. 7B-2506(9) As part of the disposition in this matter it is ORDERED that the juvenile shall not be licensed to operate a motor vehicle in the State of North Carolina for the following period: ORDER Date Name Of District Court Judge (type or print) NOTICE TO DIVISION OF MOTOR VEHICLES Signature Date Deputy CSC Assistant CSC Clerk Of Superior Court NOTE TO CLERK: Complete Side Two of this form. Mail a copy of this form to: Division of\ Motor Vehicles, 1100 Mail Service Center, Raleigh, NC 27699-1100. NC-JOIN No. AOC-J-466/DL-53J, Rev. 12/17

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