Fill and Sign the To Rescind Form

Plaintiff Defendant Attorney Name And Address Of Party Making Motion (Type Or Print) STATE OF NORTH CAROLINA(Over) Court File No. CountyIn The General Court Of Justice District Court Division AOC-CV-916M, Rev. 3/03 © 2003 Administrative Office of the Courts I hereby request the Court rescind the Affidavit Of Pare ntage that I signed. MOTION Therefore, the undersigned requests that the District Co urt order the rescission and include a specific finding tha t the motion to rescind was filed with the Clerk of Superior Court within sixty (60) days of signing the attached Affi davit Of Parentage. 1. A copy of the Affidavit Of Parentage is attached to th is Motion. Date Signature Of Party Making Motion 2. This motion was filed within sixty (60) days of the dat e that I signed the Affidavit Of Parentage. 3. To the best of my knowledge, a court order regarding the paternity of or child support for the child(ren) named in the attached Affidavit Of Parentage has not been entered. INSTRUCTIONS TO THE MOVING PARTY: A copy of the Affidavit Of Parentage that you signed must be attached to this Motion. This Motion must be filed within sixty (60) days from the date you signed the Affidavit Of Parentage or before a court order for paternity or child support is entered with respect to the child(ren) named in the Affidavit Of Parentage. After you have completed this form, file it with the Clerk of Superior Court and ask t he Clerk to schedule a hearing. Then serve the other party who signed the Affidavit Of Parentage (and the state or local child support enforcement agency if the agency is involved with the paternity or support of the child(ren) named in the Affidavit Of Parentage) through the Sheriff's office or by certified mail. If you are serving the Motion by cert ified mail, prepare and file proper affidavit of service. You will need to come to court for a hearing on the date and time specified above. NOTICE TO: (Name of party(ies) to be served) NOTICE OF HEARING AM PM You are notified to appear at the date, time and lo cation shown below to answer the above Motion And Notice Of Hearing To Rescind Affidavit Of Parentage. Date of Hearing Location of Hearing Time Of Hearing Deputy CSC Clerk of Superior Court Signature Assistant CSC Date Of Notice MOTION AND NOTICE OF HEARING TO RESCIND AFFIDAVIT OF PARENTAGE G.S. 110-132 Plaintiff's Social Security No. VERSUS Name And Address Of Defendant Defendant's Social Security No. Name And Address Of Plaintiff IV-D Case No. AOC-CV-916M, Side Two, Rev. 3/03 © 2003 Administrative Office of the Courts PARTY RETURN OF SERVICE Other manner of service: (specify) By leaving a copy of this Motion and Notice at the dwelli ng house or usual place of abode of the party named abo ve with a person of suitable age and discretion then residi ng therein. By delivering to the party named above a copy of this Moti on and Notice. I certify that this Motion and Notice was received and serve d as follows: Name And Address Of Person With Whom Copies Left The party WAS NOT served for the following reason: Name Of Party Date Served Time Served (County IV-D Agency) By personally delivering a copy of this Motion and Notice to the county manager, a county commissioner or the clerk to the board of county commissioner s named below. (State IV-D Agency) By personally delivering a copy of this Motion and Notice to the designated process agent for the Department of Health and Human Services named below. Name Of IV-D Agency IV-D AGENCY Name, Title And Address Of Person Served Name, Title And Address Of Person Served Name Of Sheriff (Type Or Print) County Of Sheriff Signature Of Deputy Sheriff Making Return PM AM PM AM Date Served Time Served $ Service Fee Paid Date Received Date Of Return