15
STATE OF NORTH CAROLINA COUNTY OF CHATHAM Plaintiff Name CHATHAM on behalf of ANGELA L FOXX Address 505 GRAHAM MOORE RD STALEY County NC 27355-8298 VERSUS Defendant Name THOMAS D WILEY TO: Name & Address of First Defendant THOMAS D WILEY 1407 WASHINGTON AVE APT# SILER CITY NC 27344-2044 CIVIL S TO: ;-:--,• IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION DOCKET IV-D FILM # l:Jc VD4-0I # 0006281424 # GS 1A-1, Rules 3,4 Name & Address of Second Defendant APT # A Civil Action Has Been Commenced Against You! You are notified to appear and answer the complaint of the plaintiff as follows: 1. Serve a copy of your written answer to the complaint upon the plaintiff or his attorney within thirty (30) days after you have been served. You may serve your answer by delivering a copy to him or by mailing it to him at his last known address, and 2. File the original of the written answer with the Clerk of Superior Court of the County named above. If you fail to answer the complaint the plaintiff will apply to the Court for the relief demanded in the complaint. Name and Address of Plaintiff's Attorneg !Date !Time Issued I loU ex II'S I1J:a7 ( )AM ( V'PM If none,Address of Plaintiff SAMANTHA H CABE 127 TIMBERHILL PL CHAPEL HILL (919) 928-5701 NC 27514 I Signature'), 1 .• \ () '. L 1 I (V?oeputy esc ( ) Assistant esc I( ) Clerk of Superior Court ) ENDORSEMENT This summons was originally issued on the date indicated above and returned not served. At the request of the plaintiff, the time within which this summons must be served is extended sixty (60) days. !Date of endorsementiTime I I Issued ( )AM ( ) PM I ISignature 1----------------------------------- 1 ( ) Deputy esc ( ) Assistant esc I( ) Clerk of Superior Court (Continued)

loU II'S - WordPress.com · 15/06/2015 · ess of person with whom copies left (If corporation give title of person copies left with) ... JUDGMENT ABSTRACTING JMT JUDGMENT IN DOCKET

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STATE OF NORTH CAROLINA COUNTY OF CHATHAM

Plaintiff Name CHATHAM on behalf of ANGELA L FOXX

Address 505 GRAHAM MOORE RD

STALEY

County

NC 27355-8298

VERSUS

Defendant Name THOMAS D WILEY

TO:

Name & Address of First Defendant THOMAS D WILEY 1407 WASHINGTON AVE APT#

SILER CITY NC 27344-2044

CIVIL S

TO:

;-:--,•

IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION

DOCKET IV-D FILM

# l:Jc VD4-0I # 0006281424 #

GS 1A-1, Rules 3,4

Name & Address of Second Defendant

APT#

A Civil Action Has Been Commenced Against You!

You are notified to appear and answer the complaint of the plaintiff as follows:

1. Serve a copy of your written answer to the complaint upon the plaintiff or his attorney within thirty (30) days after you have been served. You may serve your answer by delivering a copy to him or by mailing it to him at his last known address, and

2. File the original of the written answer with the Clerk of Superior Court of the County named above.

If you fail to answer the complaint the plaintiff will apply to the Court for the relief demanded in the complaint.

Name and Address of Plaintiff's Attorneg

!Date ~ssued !Time Issued ~

I loU ex II'S I1J:a7 ( )AM ( V'PM If none,Address of Plaintiff SAMANTHA H CABE 127 TIMBERHILL PL

CHAPEL HILL (919) 928-5701

NC 27514

I Signature'), 1

.• \ () '. L

1 ~ vtt1CJ.V~ I (V?oeputy esc ( ) Assistant esc I ( ) Clerk of Superior Court

----------------------------------------~----------------------------------------) ENDORSEMENT

This summons was originally issued on the date indicated above and returned not served. At the request of the plaintiff, the time within which this summons must be served is extended sixty (60) days.

!Date of endorsementiTime I I

Issued ( )AM ( ) PM

I 1------~-------ISignature

1-----------------------------------1 ( ) Deputy esc ( ) Assistant esc I ( ) Clerk of Superior Court

----------------------------------- 1----------------------~--~--=----(Continued)

RETURN OF SERVICE

I certify· · ·his summons and a copy of complaint were received and served as follows:

Defendant 1.

!Name of Defendant

_._lu=---.;:;J__,.u....__.4~t.t;,..........#-l~=---1 ______ ____:_·fh_vrrd_5_D_. vJ_,_l~-+------Date ser.·e:::

(YJ (

ng to the defendant named above a copy of the summons and complaint. :1g a copy of summons and complaint at the dwelling house or usual place of abode of the t named above with a person of suitable age and discretion then residing therein.

defendant is a corporation, service was effected by delivering a copy of the summons and hint to the person named below.

ess of person with whom copies left (If corporation give title of person copies left with)

1-----------------------------------------------------------------------l ( ) Other manner of service (specify) I I

Defendant WAS NOT served for the following reason.

Defendant 2.

Date served !Name of Defendant I

-· .......

-----------------~------------------------------------------~---------

I

By deli\'ering to the defendant named above a copy of the summons and complaint.

By lea\·ing a copy of summons and complaint at the dwelling bouse or usual place of abode of·t@ defendant named above with a person of suitable age and discretion then residing therein. . ~

:J

As the defendant is a corporation, service was effected by delivering a copy of the summons and complaint to the person named below.

Name and address of person with whom copies left (If corporation give title of person copies left with)

Other manner of service (specify)

-.9

• ,:.. 1

1--~--------------------------------------------------------------l ( Defendant WAS NOT served for the following reason.

Service Fee PaidiDate Received !Name of Sheriff

$ I; o2 .J44t-? t 5 I ~RL...(<I/:::z._'__,_ft.~L-t::.<le};~.;...Ljfir:~Y--------!Date of Ret~rn!?Z ~

1/6;:TWL [$ 1De£,~#if ki:~/Jurn ---~~ I #l!dae~A~ 41/~

DSS-4668 (09/11)

By

CSS/ACTS

Payor Name:

Payee Name:

t

XXX County Clerk of Superior Court CIVIL RECEIPTING

C ht1±harn · Co. (Party to Case)

(Pd by: attorney, interested party, etc.)

,, .. ~ ""

l5C \/]24-0l FILE NUMBER

Flag for VCA:f =YES . Flag for VCAP =NO

•.

FILING FEES: (ol"iginal/counterclaim/cross-claim) FILING FEES:

C :D ·De - <}}· d.d.5 • Db ~VSC Superior $ 200.00 0 CVDC District $ 150.00

D CVMC Small Claim $ 96.00 ~ .. - -- ···- - ·-

I..--JUDGMENT ABSTRACTING JMT JUDGMENT IN DOCKET BOOK --

.Book Page SERVICE FEES: SERVICE FEES:

0 WRIT OF EXECUTION 21430 $ 0 WRIT OF EXECUTION 21400 $ 0 WRIT OF POSSESSION 21430 $ 0 WRIT OF POSSESSION 21400 $ 0 SHERIFF 22515 $ 0 SHERIFF 22515 $

JUDGMENT PAYMENT: JUDGMENT PAYMENT:

(] Full D Partial D Full D Partial

0 JUDGMENT 26115 $ D JUDGM ENT 261 20 $ 0 ATTY FEE JUDGMENT 24610 $ 0 BOND FORFEITURE 22800 $ 0 ATTY APPT FEE JUDG 26115$ (PRIOR TO JUDGMENT) 0 BOND FORFEITURE 22800 $ 0 BOND FORF COST 26115 $ 0 ARBrTRATION (JA) M#S 26115 $ 0 TRANSCRIPT FEE .21400 $

Transcript # .. 0 TRANSCRIPT FEE 21440 $ County 0 SUPPL PROCEEDING 21400 $ 8 3UPPL PROCEEDH'~G 21489-$

. 0 MOTteN FEE N. (). H- ' 21450 $ 0 A&P/ENDORSEMENTS 21455 $ ·D{!_P-9. s ~+ Pa~ah/e Cli.Q/.Qoo "P,.e_ \'\ +-t:l .?-LQ?-:10

f--· · 5c~rp\ lA-5 FL-L-v--d 5

MISCELLANEOUS FEES: MISCELLANEOUS FEES: 0 MISC FILING FEE· 21435 $ 0 MlSC FILING FEE 21400 $ (CLOL,LISP.LIENS) D COPY 21410 $ 0COPY 21410 $ D CIVl L BON OS 26210 $ D CONFESS JUDGMENT . 21400 $ 0 CONDEMNATION 26130 "$ 0 TRIAL DE NOVO 24310 $ D TRUST (Minor's portion) 26310 $ 0 CIVIL BONDS 26210 $ 0 ARBITRATION FEES 24311 $ 0 OUT OF STATE ATTY 24625 $ (CVD - BEFORE JUDGMENT)

($200) 0 VSA, REGISTRATION , PASS-D OUT OF STAT!t'ATTY 24626$ PORTS, ETC. 21400 $

BAR FEE ($25) 0 LIS PEND ENS 21400 $ D $ D UPSET BID 26700 $

"

-OTHER ACCOUNT~#

·- -----

:Pt.t·{ge p_(Q4 ( 0 -DATE:

!rJ!JJ J J Ff TOTAL: I 50. oo

··-

CHA THPJ'f COUNTY CLERI< OF COURT

H029889 06/12/15 13:02:52

PAYOR: CHATHAM COUNTY PAYEE: CASEil: 15CVf~00401 VCAP:Y CIT Ail:

21220 DC-CIVIL FEES 21221 ffC-CV LM FEES 24681 JUff TECH & FAC 22220 CO F AC FEE D CV

TOTAL PAin CO TENDERED

CHANGE

1095 ID C18TAC

127.55 2.45 4.00

16.(?(]

150.00 150.00

.oo

STATE OF NORTH CAROLINA FILED ~FileNo ~~VD LfO I

CHATHAM County In The General Court Of Justice

District Court Division Name And Address Of Plaintiff 1 LUI) JUN I Pft 1z: Z I CHATHAM COUNTY DSS 0/B/0

[CHA THPJ-'\ C )UNTY C.S.C. DOMESTIC ANGELA FOX.X

~IVIL ACTION COVER SHEET. l

Name And Address Of Plaintiff 2 fW ---·· r---l)a- TNTTIAL Fl L1 NG 0 SUBSEQUENT FILING

Rule 5(b) , Rules of Practice For Superior and District Courts

VERSUS Jury Demanded In Pleading? lil No DYes Name Of Defendant 1 Name And Address Of Attorney Or Party, If Not Represented (complete for initial

appearance or change of address)

SAMANTHA CABE

THOMAS D. WILEY 127 TIMBERHILL DRIVE CHAPEL HILL NC 27514

Summons Submitted GCJ YesD No Telephone No. I Cell Telephone No. Name Of Defendant 2

919-928-5701 NC Attorney Bar No. I Attorney E-Mail Address

28461

[KJ Initial Appearance in Case I D Change of Address Summons Submitted DYes 0No Name Of Firm

Counsel for

GCJ All Plaintiffs D All Defendants D Only (List party(ies) represented) FAX No.

I TYPE OF PLEADING ~ I CLAIMS FOR RELIEF FOR: I (check all that apply) (check all that apply)

D Amended Answer/Reply (AMND-Response) 0 Alimony (ALIM)

D Amended Complaint (AMND) 0 Annulment (ANUL)

D Answer/Reply (ANSW-Response) [KJ Child Support (CSUP)

li] Complaint (COMP) 0 Custody (CUST)

D Confession Of Judgment (CNFJ) O Divorce (DIVR)

D Contemp (CNTP) Assess Motions Fee O Divorce From Bed And Board (DIVB)

D Continue (CNTN) Assess Motions Fee 0 Domestic Violence (DOME)

D Compel (CMPL) Assess Motions Fee 0 Equitable Distribution (EQUD)

D Counterclaim vs. (CTCL) Assess Counterclaim Costs li] Medical Coverage (MEDC)

D Extend Time For An Answer (MEOT-Response) Assess Motion Fee 0 Paternity (PATR)

D Modification Of Alimony (MALl) Assess Motions Fee 0 Possession Of Personal Property (POPP)

D Modification Of Custody (MCUS) Assess Motions Fee 0 Post Separation Support (PSSU)

D Modification Of Support in non-IV-D cases (MSUP) Assess 0 Reimbursement For Public Assistance (RPPA)

Motions Fee 0 Visitation (VIST)

D Modification Of Visitation (MVIS) Assess Motions Fee 0 Other: (specify and list separately)

D Rule 12 Motion In Lieu Of Answer (MDLA) Assess Motions Fee D Santions (SANC) Assess Motions Fee D Show Cause (SHOW) Assess Motions Fee D Transfer (TRFR) Assess Motion Fee D Vacate/Modify Judgment or Order (VCMD) Assess Motions Fee D Other (OTHR): (Use codes from Motions Coversheet

AOC-CV-752 or specify)

Date

t, -II- :2.0 I s ·~ -NOTE: All filings in civil actions shalf include as the first page of the filing a cover sheet siJrr'rr1farizing the critical elements of the filing in a format prescribed by the

Administrative Office of the Courts, and the Clerk of Superior Court shalf require a party to refile a filing which does not include the required cover sheet. For subsequent filings in civil actions, the filing party must include a Domestic (AOC-CV-750) Motions (AOC-CV-752) or Court Action (AOC-CV-753) cover sheet.

AOC-CV-750, Rev. 6/11 © 2011 Administrative Office of the Courts

STATE OF NORTH CA~OLINA COUNTY OF CHATHAM

CHATHAM COUNTY on behal·f of

ANGELA L FOXX vs

THOMAS D WILEY

TO: THOMAS D WILEY 1407 WASHINGTON AVE SILER CITY, NC 27344-2044

FILED

1015 ~~ f 2 Pj~ 12= 2 7

IN THE GENERAL COURT OF DISTRICT COURT DIVISION

DOCKET # Jx v _o 4-o 1 IV-D # 0006281424

!CHATHAM COUNTY CrW;fiCE OF HEARING Plaintiff,)

cov ) /\ttl 1 Daf..enda.rlW f ~ . ...._.._. __

PLEASE TAKE NOTICE that the undersigned will bring the COMPLAINT FOR CHILD SUPPORT & MED INS for hearing on the 7TH day of AUGUST , 2015, at 09:00 AM, at the CHATHAM County Courthouse, Room 2A , PITTSBORO , North Carolina.

DSS-4621 03/01

This the __ II __ day of _Jwl_e ___ , 2oJi_.

IV-D ATTORNEY SAMANTHA H CABE 127 TIMBERHILL PL CHAPEL HILL, NC 27514. (919) 928-5701 Attorney Bar#: 3700028461

CSS/ACTS For more information or online payments go to WWW.NCCHILDSUPPORT.COM

JUSTICE

I

STATE OF NORTH CAROLINA COUNTY OF CHATHAM

CHATHAM County on behalf of

ANGELA L FOXX Plaintiff,

vs.

THOMAS D WILEY Defendant.

FILED

l015 JUM J 2 PM 12: 2 7 ' )

CHATH~M COUNTY C.S.C.

I ) t"it l qv ) ~ I I --7·~------~-·----

) ) ) )

IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION

DOCKET # } 5C v D LtD} IV-D # 0006281424

COMPLAINT

The Plaintiff, complaining of the Defendant, alleges and says:

1. The CHATHAM County Child Support Enforcement Agency is the_ "Designated Representative" in CHATHAM County as that term is defined N.C.G.S. 110-129(5) and that this action is brought under authority granted in Article 9, Chapter 110 of the North Carolina General Statutes.

2. The Caretaker is a citizen and resident of CHATHAM North Carolina.

3. The minor child(ren), ALIZABETH WILEY QUENTIN D WILEY

are citizens and residents of the State of North Carolina.

4. The Defendant is a citizen and resident of SILER CITY

5. Defendant is the father of the minor child(ren).

County,

I NC.

6 . Defendant is a "Responsible Parent" as defined by 110-129(3) and has a legal duty to provide support.

7. The minor child(ren), ALIZABETH WILEY QUENTIN D WILEY

are in need or will be in need of support from Defendant for the child(ren) 's health, maintenance, and education including medical insurance coverage.

8. The Defendant has failed or refused to adequately contribute to the support and maintenance of his/her minor child(ren),

ALIZABETH WILEY QUENTIN D WILEY

9. The Plaintiff, pursuant to Article 9 Chapter 110 and N.C.G.S. 50-13.4, is entitled to an order obligating the Defendant to pay support for his/her minor child(ren).

10. The Plaintiff has applied to the CHATHAM County Child Support Enforcement Agency for child support enforcement and collection services pursuant to N.C.G.S. 110-130.1.

11. Defendant is and has been an able bodied person, capable of providing child support through all times relevant to this action.

WHEREFORE, the Plaintiff prays the Court:

I

'I I

1. Order the Defendant to provide such continuing support and maintenance for said child(ren), in an amount to be determined for each child, as required by the North Carolina Child Support Guidelines, N.C.G.S. 50-13.4.

2. Order the Defendant to provide medical insurance coverage or medical support for said dependent child(ren) pursuant to N.C.G.S. 50 - 13.11.

3. Order all sums paid under the terms of any order entered be made to NC Child Support Centralized Collections for transmittal to the North Carolina Department of Health and Human Services or its designee for appropriate distribution pursuant to the provisions of Article 9 Chapter 110 of the N.C.G.s:

4. Order immediate income withholding from the Defendant's wages or other sources of disposable income.

5. Order the Defendant taxed with the cost of this action, and the share of costs attributed to reasonable attorney's fees allowed by authority of N.C.G.S. 50-13.6.

6. Order such further relief as the Court deems just and proper.

This the

DSS-4535 10/99 CSS/ACTS

ll day of

127 TIMBERHILL PL

CHAPEL HILL NC 27514-0000

-:::.,. . 08/ 10/ 2009 21:32

' ,-. ORANGE COUNT~ rr. 0. D. PAGE 02

21'5lJlp

NO!tTH CAROLINA 0111'111HMI:~T OF H~~ TH ANO 11UMAN SERVICeS ::!009012421110 183170 8 ! RTH "CVIT .. ~ l'ECOI\03 Bk :88!5 Pg: 707

CERTIFICATE OF LIVE BIRTH G7t.a412009 02 59 24 "" 111

BIRTH NO. - 13~

' '

STATE OF NORTH CAROLINA ORANGE COUNTY

OFFICE OF REGISTER OF DEEDS

Local No.

1. CHILO'S NAME (Fim. - · Lalli)

NORTH CAROUNA DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTER FOR HEALTH STATISTICS • NC VITAL RECORDS

CER11FICATE OF LIVE BIRTH BOOK PAGE

81

Ub. COLOR OR RACE OF loiOTI£R (Sp.olty -· Bledl", M1erlcan H.-., efc.)

Black

This is to certify that this ;s a true and correct reproduction or abstrac t of the official record filed in this office.

068-12.5721 W1tness ~officia l s~ this the _ ____ V:;_ day of f!/. . ,. DHHS 3914 (REVISED ~/061 NC VITAL RECORD S·

Joyce H. Pearson Register of Deeds

Orange County

Any aJterauon or eraScure void~ th1~ cenificate. Do not accept un l e~:-. on :-.e1.:urity paper with Vital Records seul clearly emho,scd in left ~.:omer

(-~·~-:" , .

\3V(b

Pittsboro, NC 27312

Wo aro <:lftomntino tf\ vorifv inff\rm'Jiftf\n rt:>O<:lrrlino tho nor~f\n li~tPrl , '- .. - ------....... r ............ o "'"' , -"" .... J .. A.A ... ..., ........... - ...... "-' ....... -t=t-· -···o ....... - r-· ....,_ ............. LJ ... --

above or their relative. This is needed in order to process benefits for public assistance. Please send the verified information as soon as possible. Thank you for your cooperation.

~eath Certificate

Child's Name e Suppose irtti Date ~ .... \"iS , () 3 Place of ir eatb-CJI\~f./ 1'@ /)A,(_ Race_.~--Father's ·e ·\\\.o'l'A..a..;;. ~en-- I 5R. W 1 ley Mother's Maiden Name ~~e\o. ___ l yp..e.~\a.... f-o'X x

v'£erified Information

CENTERf"O& HEP _......__ STATISTICS - N.C. VITAL RECORDS ~ • b

AFFIDAVIT OF PAiffiNTr. .,_-..:. FOR CHILD BORN OUT OF WEDLOCK T• I . 1

- ·• (Type or~rint all information) Quant ln .1 Jart1;e 1 W1 lf}y

VVeherebyaffinnthat ________________ ~--~----------------~--~~---------------------------------( full Name of Child) l (Social Security Number, if Available)

I Febrnarv P:1 :~00:-t,. • . Pt~pel Ht t t ,Oranqe who was born • .::! , m -

(ij}ate of Birth}' I (City. County of Birth)

at UNC Hof'>p1 ta 1"' ·'' Affidavit signed at _J_fo_. ::_~·P.::.... _t_t._.'\_1 _________ _ (HospitQl or Institution) If neither, street address) (Hospital, N-D, Clerk of Court, Other)

'I'h~nt<ltt; J Dart !".e 1'1'11 ey ;:.:n 2':. 14f'IUI is the natural child of ----'---·--~---------t"T---~~----------T--------------------------------------

11 l ._, (F!lll ame of.Father)I(Socia.f Secu~ity Number) t1Cil'7 ~a~htnqt.oH ,.,_vr.~ue .~~·("(' ,_.ny,r+.. ~:11/JIJI

(Address) A nqf~ 1. n -.

r.j

Lyn~tta Fox:-: wd ________________ -7~---------------------------r--~-------------------------------

111-:~·l ••;.. {Full Maiden Nfl!'letofMoth~r}l(~ocial S. urity Number) C!l".t_ll"'m Q __ "'_'" ___ \_k_,_:.:_h_i_~ ___ :_o_r_' _A __ --fe-}:_·'''_lb ___ ._,_,_,_. f.!_~c ___ \~-~ __ ·i,_'~·-~ ___ ·_··_'_·.,_t""-~-+----------------------.. --~ __ a~-----0 {Address) ·1 (County of Residence)

~ n 1 arlr f. INFORMATION CONCERNINGtHE FAT~~r.uaP-,' ~l~ 1 <"~69 Race ____________________ ~--------------------- ·Birthdate ______________________________ ___

(Specify White, Black, Am Indian, etc.) i Nnrtl)("f~tP,,!NJ! r.~.r) , ,,

)-

Is Father of Hispwic origin? D Yes D No 'irthplace _____________________________ __

If yes,.specify-Guban,,-----------------------'~•---...,.... ,_(County, State or Foreign Coull(~)~ . ...-

Mexican, Puerto Rican, etc. ------------------ f<!ucation -----------------------~=------

,1 (Highest Grade Completed Elem 1-8.

High 9-12, Col 13-17+)

CERTIFICATION OF PARENTS ~ I acknowledge that I have received and understand the oral instructions and the information on the other side of 1'·

this form that explains the purpose and consequences of signing this document, including possible requirements iif:;; pay child support.

Mother I am the natural mother and the man named above is the natural father of Jlfe child named above. I also declare and affirm that I ~as unmarried at my child's conception or birth. I D was married to someone other than the above-named father when I became pregnant with the above-named child

"' wNm <I• 1hild .,, 7k;' Io'"~'w~. #I J

Signature of Mother lac ~ (and parent, guardian or custodial adult if minoF'/norher) . . -- -~~~·

Sworn toj;~ubscribed befo're me this ~~.~,·". day of , «Zf . , -!j (SEAL)

/6;4Jke ,!]. ~ (

'

/Verified Information ----'--

___ Certified Copy

v-o~· rJ.."t ... "~ ro nept Soc Se-... ,:ne" .l. ' 1 111. vJia 114111 'L- JJ .l T H .. ;,

John Tanner, Director PO Box 489 Pittsboro, NC 27312

Case Name:~ d)j,eJ «__ f0A)< Date '3-:cl_- _

Wt> -:.rt> -:.ttt>rnntiniT to Vt>rifv inforrn<:~tion rt>IT-:.rrliniT tht> nt>r~on li~tt>rl 'f- -·- - ...... - ........ .., ............. 0 "'-' 1' -· AA.J A.A....&A..._,A ···---AVAA A -&-A -AA&b ._ .... - .... - ... "-'VA....& 4A~ ... --

above or their relative. This is needed in order to process benefits for public assistance. Please send the verified information as soon as possible. Thank you for your cooperation.

~eath Certificate

Child's Name ~~--~~~~~~--~~~~~--~~~~~-----

Suppose irth Date ~- \'75 - u 3 Place of · eat11-CJ1~·f-/ 1'@ /)At(_ Race---,---, ~--Father's ·-e \\\..•J\'-'"-o..:.. \:>o.r: i ~e v_}' le)' Mother's Maiden Name "'h% e \Q,"' L ,..f', e~\o._. Fo )1. ;x

vYerified Information

Child's Name Sex Race -------------------------- ----~ate Father's Name ________________ _ Mother's Name -------------------------------------------Recorded: Volume ____________ Page Certificate No ___ _

j)Jtuj0j

:;Jn aJI,l1 "---

~gned: ~WaJ & vTitle YliJ

--~~~~--------------

~ate 2j~/6b

NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION

CHATHAM COUNTY CVD --- ---

STATE OF NORTH CAROLINA Ex rel.,

IV-D #

ANGELA FOXX, Plaintiff AFFIDAVIT

Vs

THOMAS D. WILEY, Defendant

THE UNDERSIGNED, being duly sworn, deposes and says the following:

1. That I am the agent at Chatham County Child Support Enforcement assigned to the above-captioned case.

2. That I have used the services of the Defense Manpower Data Center, specifically Military Verification, to determine whether the above-referenced Defendant is currently in the military.

3. As a result of my search, I found that the above-referenced Defendant

Is currently on active duty in the military.

XX Is not currently on active duty in the military.

I was not able to learn whether the above-referenced Defendant is in the military.

FURTHER, the affiant sayeth naught.

This the 28th day of May, 2015.

Jan C. Beal Sworn to and Subscribed Before Me, This th~ 28th day ofM , 2015.

STATE OF NORTH CAROLINA COUNTY OF CHATHAM FILENO.

VERIFICATION

I, Jan c. Beal, first being duly sworn deposes and says that she is the designated representative of the Plaintiff in the foregoing action; that she has read the foregoing attached complaint and that the contents of said complaint are true to her own knowledge except as to those matters and things stated upon informat1on and belief and as to those she believes to be true.

This 28th day of May, 2015.

CHILD SUPPORT AGENT

sworn to and subscribed before me this the 28th day of May, 2015.

ission expires: KATHLEEN SCARBOROUGH

NOTARY PUBLIC --+-----r-:t:Nt"n:::!'::l~,....,OU NTY, N.C.

My Commission Expires 11-05-2017