File No. STATE OF NORTH CAROLINA In The General Court Of Justice County Name Of Petitioner 1 SPECIAL PROCEEDINGS ACTION COVER SHEET Tax ID/SSN Name Of Petitioner 2 Tax ID/SSN Rule 5(b), Rules of Practice For Superior and District Courts Name Of Petitioner 3 Name And Address Of Attorney Or Party If Not Represented (complete for initial appearance or change of address) Tax ID/SSN Name Of Respondent 1 VERSUS Tax ID/SSN Attorney Bar No. Summons Submitted Yes Name Of Respondent 2 Tax ID/SSN Name Of Firm Summons Submitted Yes Tax ID/SSN Telephone No. FAX No. No Name Of Respondent 3 Counsel for All Petitioners Tax ID/SSN Change of Address Initial Appearance in Case No All Respondents Only (List party(ies) represented) Summons Submitted Yes No APPLICATION (check appropriate box) Adoption (ADOP) Motor Vehicle Lien G.S. 44A (MVLN) Boundary Settlement (BNDR) Name Change (NAME) Cartway (CART) Partition (PART) Condemnation - Private Condemnor/Mill (CNDM) Protective Services Adult (PRSE) Dec Estate - Sell Land To Create Assets (PESE) Surplus Funds - Determine Ownership (DOSF) Decedent's Estate - Sell Prsnl Property (SLPS) Sterilization (STRL) Drainage - Individual/Corporation (DRNG) Unknown Heirs - Proceeding To Determine (TDHE) Drainage District - Establishment (DRDS) Year's Allowance - Spouse/Child (SSCA) Foreclosure (FORE) Other (specify) Incompetency (INCM) Land Registration - Torrens Act (TORR) Legitimation (LGMT) Minor's Estate - Disburse Funds (DFND) Minor/Incom Estate - Sale/Lease/Mortgage (MIES) Date Signature Of Attorney/Party NOTE: All filings in special proceedings shall include as the first page of the filing a cover sheet summarizing the critical elements of the filing in a format prescribed by the Administrative Office of the Courts, and the Clerk of Superior Court shall require a party to refile a filing which does not include the required cover sheet. AOC-SP-550, Rev. 1/02 2001 Administrative Office of the Courts (Over) No. Additional Petitioner(s) No. Additional Respondent(s) AOC-SP-550, Side Two, Rev. 1/02 2001 Administrative Office of the Courts Tax ID/SSN Tax ID/SSN Summons Submitted Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No