Fill and Sign the When Person Not Present Form

NOTE: The effective date specified herein is four (4) days after the Order i\ s mailed. Count the four (4) days beginning with the day following the\ day of mailing pursuant to G.S. 1A-1, Rule 6. See reverse for Supplemental Find\ ings and Order, and for Disposition of License or Privilege. STATE OF NORTH CAROLINA F ile No. IN THE MA TTER OF Name And Address In T he G eneral Court Of Justice District Court Division County G.S . 20-16.5 Original-F ile Copy-Person Whose License Revoked (Over) AOC-CVR-3, Rev. 4/14 © 2014 Administrative Office of the Courts The undersigned judicial official finds probable cause to believe that: 1. A law enforcement officer had reasonable grounds to believe that t he above-named person committed an offense subject to the implied-consent provisions of G.S. 20-16.2; 2. The above-named person has been charged with that offense as provided in G.S. 20-16.2(a); 3. Both the law enforcement officer and the chemical analyst(s) complied with the provisions of G.S. 20-16.2 and 20-139.1 in requiring the above- named person's submission to or procuring a chemical analysis; and 4. The above-named person: □ a. willfully refused to submit to a chemical analysis. □ b. had an alcohol concentration of 0.08 or more at any relev ant time after the driving. □ c. had an alcoho l concentration of 0.04 or more at any relev ant time after the driving of a commercial motor v ehicle. □ d. had any alcohol concentration at any relev ant time after the driving, and at the time of the offense, was under 21 years of age. □ 5. The above-named person has one or more pending offenses in the following county(ies) \ \ for which the person's drivers license had been or is revoked under G.S. 20-16.5. ORDER FINDINGS FOR PROBABLE CAUSE REVO CATION ORDER WHEN PERSON NOT PRESENT It is ORDERED that the above-named person's drivers license or privilege to drive be revoked, and the above-named person is prohibited from operating a motor vehicle on the highways of North Carolina during the p\ eriod of revocation; and the revocation remains in effect at least thirty (30) days from: □ 1. the date he/she surrenders his/her drivers license or privilege to drive\ to the court, or demonstrates that he/she is not currently licensed to drive, if he/she does so within five (5) working days of the effective date of t\ his Order (the failure of the above-named person to act within five (5) working days will result in a longer revocation period as explained in the Notic\ e below) ; or □ 2. (check this option if Finding No. 5 is checked) the date he/she surrenders his/her drivers license or privilege to driv\ e to the court, or demonstrates that he/she is not currently licensed to drive, if he/she does so within\ five (5) working days of the effective date of this Order (the failure of the above- named person to act within five (5) working days will result in a long\ er revocation period as explained in the Notice below) , and indefinitely until a final judgment, including appeals, has been entered for the current offe\ nse and for all pending offenses for which his/her drivers license or pr\ ivilege to drive had been or is revoked under G.S. 20-16.5. The above-named person's privilege to drive in North Carolina is revoked\ and will remain revoked until the person has actually surrendered his/her license for the period specified above and has paid a $100 fee t\ o the Clerk of Superior Court. I am informing the above-named person of his/her right to a hearing by e\ xplaining this right in the Notice below. I am delivering a copy of this Order to him/her by depositing it in the United States mail as provided in G.S. 2\ 0-16.5(f). NOTICE Your license to drive is revoked as of the effective date shown above. If within five (5) working days of the effective date of this Order y\ ou surrender your drivers license to the Clerk of Superior Court or show you are not \ licensed to operate a motor vehicle, this Revocation remains in effect f\ or at least a thirty (30) day period beginning on the date you surrender your licens\ e or make the showing. If you fail to do so, this Revocation remains in effect for at least a forty-five (45) day period beginning on the date you surrender\ your license or make the showing. Appearance before the Clerk of Superi\ or Court must be made between 8:30 a.m. and 5:00 p.m., Monday through Friday. Your failure to appear before the Clerk of Superior Court may result in \ a law enforcement officer seizing your license or requiring you to demon\ strate you are not licensed. In this event, this Revocation remains in effect f\ or at least a forty-five (45) day period which will not begin until th\ e officer seizes your license or you demonstrate you are not licensed. If at time of this Order you have only a temporary driving certificate, \ you must surrender the certificate, and then you also must surrender you\ r license card immediately when you later receive it in the mail from DMV. If your license is revoked under Paragraph 1 of this Order, at the end o\ f the revocation period you are still prohibited from driving until you \ have paid a fee of $100 to the Clerk of Superior Court. If your license is revoked under Paragraph 2 of this Order, this Revocat\ ion remains in effect for at least the thirty (30) or forty-five (45)\ days explained above and until a final judgment, including appeals, is entered for this\ current offense and for all pending offenses for which your license has\ been or is revoked under G.S. 20-16.5. At the end of the revocation period you are \ still prohibited from driving until you have paid a fee of $100 to the C\ lerk of Superior Court. This fee is in addition to any fee you have paid or are \ to pay in connection with any other pending offense for which your drive\ rs license has been revoked under G.S. 20-16.5. The $100 fee may be paid at any time, even prior to the end of the period of revocation , between the hours of 8:30 a.m. and 5:00 p.m., Monday through Friday. Payment in person must be made in cash or by certified c\ heck, cashier's check or money order. Payment by mail must be made by certified check, cashier's check or money order, payable to the Clerk of\ Superior Cour t. If you wish to have your drivers license returned to you by mail, please enclose a stamped, self-addressed envelope with your payment. If prior to the effective date of this Order you were not licensed by th\ e North Carolina Division of Motor Vehicles or did not have a valid lice\ nse from another state, an additional $50 restoration fee must be paid to the Div\ ision of Motor Vehicles before you can drive again in North Carolina. Th\ is fee must be paid even though you are a resident of another state. EFFECTIVE DATE OF ORDER: , 12:01 a.m., □ Deputy CSC □ Assistant CSC □ Clerk Of Superior Court Date Signature Of Judicial Official AOC-CVR-3, Side Two, Rev. 4/14 © 2014 Administrative Office of the Courts SUPPLEMENTAL FINDINGS AND ORDER Date I acknowledge r eceipt of my license. Date $100 Fee Paid Signature Of Licensee Signature It is f urther found t hat a Pick- Up Order was issued f or the license o f the person named herein, and t he person on the day of , \ : □ 1. su rrender ed his/ her license to t he o fficer serving t he Pick-Up Order. □ 2. demonstrat ed to t he o fficer serving t he Pick-Up Order that he/she was not currently authorized t o drive in North Carolina. It is ORDERED that this Revocat ion: □ 1. remains in effect fo r at least forty-five (45) days from the above date and until payment of a $100 f ee to t he Clerk of Super ior Court. □ 2. (check t his option i f Findings For Probable Cause No. 5 on the reverse side is checked) is indef inite and r emains in effect fo r at least forty-five (45 ) days from t he above date and until a final j udgment, including appeal s, has been entered for the current o ffense and for all pending o ffenses for which his/her drivers license had been o r is r evoked under G.S . 20- 16.5, and until payment of a $100 f ee to t he Clerk o f S uper ior Court. ACKNOWLEDGMENT OF RECEIPT DISPOSITION OF LICENSE OR PRIVILEGE Date License Mailed Date Signature □ 1. Drivers license of person named herein r eturned t o him/ her, and r eceipt by him/ her is acknowledged below. □ 2. At the licensee's r equest, license retur ned t o him/ her by mail. License mailed on the date shown below. □ 3. License mailed t o Division o f Moto r V ehicles on date shown below, since the person named herein is not eligible t o use the license for the f ollowing r eason: □ 4. Limit ed driving privilege withheld and record for war ded t o \ County. □ 5 . Other: □ Deputy CSC □ Assistant CSC □ Clerk Of Superior Court It is further found that: □ 1. The person named herein appeared before the Clerk of Superior Court at □ AM □ PM on the day of , \ , which □ is □ is not within five (5) working days of the effective date of this Revocation Order. □ 2. The person: □ a. surrendered his/her drivers license to the Court. □ b. was validly licensed but unable to locate his/her license card and filed an affidavit which constituted surrender of the drivers license. □ c. demonstrated he/she was not currently authorized to drive in North Carolina. It is ORDERED that this Revocation: □ 1. remains in effect for at least □ thirty (30) days □ forty-five (45) days from the date set forth above and until payment of a $100 fee to the Clerk of Superior Court. □ 2. (check this option if Findings For Probable Cause No. 5 on the reverse side is checked) is indefinite and remains in effect for at least □ thirty (30) days □ forty-five (45) days from the date set forth above and until a final judgment, including appeals, has been entered for the current offense and for all pending offenses for which his/her drivers license had been or is revoked under G.S . 20- 16.5, and until payment of a $100 fee to the Clerk of Superior Court. Date Signature □ Deputy CSC □ Assistant CSC □ Clerk Of Superior Court DateSignature □ Deputy CSC □ Assistant CSC □ Clerk Of Superior Court □ Deputy CSC □ Assistant CSC □ Clerk Of Superior Court You have a right to a hearing to contest the validity of this Revocation\ before either a magistrate or a judge. To do so, a written request must\ be made within ten (10) days of the effective date of the Revocation. A hearin\ g request form is available from the office of the Clerk of Superior Cou\ rt or magistrate. Your license will remain revoked and you are not authorized \ to drive pending this hearing. If you do request a hearing but fail to appear, you forfeit the right to a hearing. IT IS UNLAWFUL FOR YOU TO DRIVE A MOTOR VEHICLE IN THE STATE OF NORTH CA\ ROLINA UNTIL YOU ARE AUTHORIZED TO DO SO. THE DIVISION OF MOTOR VEHICLES MAY ALSO DISQUALIFY YOU FROM OPERATING A \ COMMERCIAL MOTOR VEHICLE UNDER G.S. 20-17.4.