TO THE APPROPRIATE JUDICIAL OFFICIAL:
I request a hearing to contest the validity of the revocation of my drivers license which was ordered revoked on the date
set forth below.
I challenge the validity of the revocation on the following specific ground(s):
(NOTE: List the finding(s) for probable cause, as set forth on the Revocation Order, which you believe to be wrong.)
STATE OF NORTH CAROLINA
IN THE MATTER OF
Name And Address Of Petitioner
Home Telephone No.
File No.
Judicial official at the initial appearance; or
The Clerk of Superior Court; or
A Magistrate designated by the Clerk of Superior Court to receive such requests.
This request must be filed by the Petitioner within ten (10) days of the effective date of the revocation order with one of
the following:
FILING INSTRUCTIONS
1.
2.
3.
Original-File Copy-Petitioner
(Over)
AOC-CVR-5, Rev. 8/07
© 2007 Administrative Office of the Courts
REQUEST FOR HEARING TO
CONTEST LICENSE REVOCATION
In The General Court Of Justice
District Court Division
County
G.S. 20-16.5
I specifically request that the hearing be conducted by a District Court Judge.
Work Telephone No.
I understand that the hearing will be limited to the grounds I specify in this request and that the revocation of my drivers
license remains in effect pending the hearing. I further understand that this hearing must be held and completed within
three (3) working days following the date of this request, or within five (5) working days if I have requested a District
Court Judge to conduct the hearing. I also understand that my failure to appear at the hearing will result in the forfeiture
of my right to a hearing.
Signature Of Petitioner
Date License Revoked
Date
I understand that the decision of the Magistrate or District Court Judge at the hearing is final, and that there is no right of
appeal from the decision.
Deputy CSC Assistant CSC
Clerk Of Superior Court Magistrate
PM
Signature
AM
Date Of Hearing
Location Of Hearing
Time Of Hearing Date
ORDER SETTING HEARING
The defendant having requested a hearing, the undersigned hereby sets a time, date and location of hearing as shown
below.
sustained.
rescinded.
a.
b.
c.
the indefinite suspension is rescinded and a separate order shall be entered by an appropriate judicial official
revoking the petitioner's drivers license for an appropriate period.
Magistrate
STATE OF NORTH CAROLINA
File No.
a.
b.
c.
all were met.
at least one was not met.
other than the current offense, there are no additional pending offenses for which the person's drivers license
had been or is revoked under G.S. 20-16.5.
was held and completed within the required time limits.
was not held and completed within the required time limits.
a.
b.
As to each condition alleged by the law enforcement officer and chemical analyst in this matter,
The hearing
AOC-CVR-5, Side Two, Rev. 8/07
© 2007 Administrative Office of the Courts
Original-File Copy-Petitioner
FINDINGS AND ORDER
IN CONTESTED LICENSE REVOCATION
In The General Court Of Justice
District Court Division
County
IN THE MATTER OF
G.S. 20-16.5
Name And Address Of Petitioner
The Court finds that the petitioner filed a timely Request For Hearing To Contest License Revocation form setting forth
the specific grounds upon which the validity of the revocation is challenged.
The Court, having considered the evidence and arguments presented at the hearing, finds by the greater weight of the
evidence the following:
1.
2.
Based upon the foregoing findings of fact, the Court CONCLUDES and ORDERS that the revocation of the petitioner's
license be:
Signature Of Judicial Official
Judge
Name Of Judicial Official (Print Or Type)
Date
