STATE OF NORTH CAROLINA ~FileNo.

L:2 tt/11 .i~ L-CHATHAM County

In The General Court Of Justice ~ District Court Division

Name And Address Of Plaintiff 1

CHATHAM COUNTY DSS O!B/0 DOMESTIC INGRID MORALESRODRfGUEZ ]:'I . l'>ot n A . ..... -u. J ' .. - . .

- CIVIL ACTION COVER SHEET. Name And Address Of Plaintiff 2

( .. . :l?'J INITIAL FILING 0 SUBSEQUENT FILING 'I

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

VERSUS Jury Demanded In Pleading? lia No 0 Yes Name Of Defendant 1 Name And Address Of Attorney Or Party, If Not Represented (complete for initial

GERARDO G. LOPEZ appearance or change of address)

SAMANTHA CABE 127 TIMBERHILL PLACE CHAPEL HILL NC 27514

Summons Submitted liJ Yes 0 No Telephone No. I Cell Telephone No.

Name Of Defendant 2 919-928-570 I

NC Attorney Bar No. I Attorney E-Mail Address

28461

~ Initial Appearance in Case I O Change of Address Summons Submitted DYes 0No Name Of Firm

Counsel for

l)d All Plaintiffs 0 All Defendants 0 Only (List party(ies) represented) FAX No.

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

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

0 Amended Complaint (AMND) D Annulment (ANUL)

0 Answer/Reply (ANSW-Response) oo Child Support (CSUP)

li] Complaint (COMP) D Custody (CUST)

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

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

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

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

0 Counterclaim vs. (CTCL) Assess Counterclaim Costs 00 Medical Coverage (MEDC)

0 Extend Time For An Answer (MEOT-Response) Assess Motion Fee 00 Paternity (PATR)

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

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

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

Motions Fee D Visitation (VIST)

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

0 Rule 12 Motion In Lieu Of Answer (MDLA) Assess Motions Fee O Santions (SANC) Assess Motions Fee 0 Show Cause (SHOW) Assess Motions Fee 0 Transfer (TRFR) Assess Motion Fee 0 Vacate/Modify Judgment or Order (VCMD) Assess Motions Fee O Other (OTHR): (Use codes from Motions Coversheet

AOC-CV-752 or specify)

<:: ~ 1\ll Date

ltJ-6- zo tt r~ ~ NOTE: A// filings in civil actions shall include as the first page of the filing a cover she'~~ ing 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 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. 6111 © 2011 Administrative Office of the Courts

STATE OF NORTH CAROLINA COUNTY OF CHATHAM

CHATHAM COUNTY on behalf of

INGRID MORALESRODRIGUEZ vs

GERARDO G LOPEZ

TO: GERARDO G LOPEZ 825 GOLDEN HORSESHOE LN SANFORD, NC 27330-7311

) )

!N THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION

DOCKET # \ S Q_ \({) ~ 'L IV-D # 0007453446

• .,1. ,.,, '") • )

1,_ QTICE OF HEARING

lL Jp ain~i! f£ 1 \) t ~ • ..J _: )

Defendant.) , ,.. C

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

DSS-4621 03/01

This the __2_ day of _J_v_r1e"'-----' 20_1_~_

IV~-------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

STATE OF NORTH CAkvLINA COUNTY OF CHATHAM

~~ THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION

DOCKET # ' s e_.v'iLS ~ L IV-D # 0007453446

CHATHAM County, on the behalf of

INGRID MORALESRODRIGUEZ

VS.

GERARDO G LOPEZ

Plaintiff,

Defendant.

') ,, '" )

) ) ) ) )

1"'1 - u - ' : t: COMPLAINT

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

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

2. The Mother or Caretaker is a citizen and resident of CHATHAM County, North Carolina.

3. The minor child(ren), MATTHEW A LOPEZ is/are a citizen and resident of the State of North Carolina.

4. The Defendant is a citizen and resident of SANFORD I NC.

5. The Defendant and the natural mother of the child(ren) named below engaged in one or more acts of sexual intercourse within the State of North Carolina which resulted in the conception of the minor child(ren) named below on the date set forth, which subjects the Defendant to the jurisdiction of the District Court of North Carolina pursuant to N.C.G.S. Sections 1-75.4 and 49-17.

6. INGRID MORALESRODRIGUEZ is the mother of the minor child(ren) born to her out of wedlock, who according to the copy(ies) of the birth certificate(s) attached hereto was/were born on the date(s) and named as follows:

CHILD: MATTHEW A LOPEZ BORN: 03/02/2014

7. Upon information and belief the defendant, GERARDO G LOPEZ , is the biological father of said minor child(ren), MATTHEW A LOPEZ

8. INGRID MORALESRODRIGUEZ , mother of the minor child(ren) named above has signed an Affidavit of Parentage attached hereto naming the Defendant the biological father of the minor child(ren).

9. The Plaintiff is entitled to an adjudication pursuant to Article 9 of Chapter 110 and Article 3 of Chapter 49 of N.C.G.S., that the Defendant is the biological father of the child(ren) named above.

Cont 'd ...

10. The minor child(ren), MATTHEW A LOPEZ is/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.

11. The Defendant has failed or refused to adequately contribute to the support and maintenance of his minor child(ren), MATTHEW A LOPEZ

12. 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 minor child(ren), MATTHEW A LOPEZ

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

14. 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:

1. Adjudicate the Defendant the father of the minor child(ren), MATTHEW A LOPEZ pursuant to Article 3, Chapter 49 of the N.C.G.S.

2. 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.

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

4. Order all sums payable under the terms of any order entered be made payable to NC Child Support for appropriate distribution pursuant to the provisions of Article 9 Chapter 110 of the N.C.G.S.

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

6. Order the Defendant taxed with the cost of this action, including the costs of paternity testing and the share of costs attributed to reasonable attorney's fees allowed by authority ofN.C.G.S. 6-21(10).

Cont'd ...

7. Order such further relief as the Court deems just ctnd proper.

This the ~---5 __ __

DSS-4534 (04/12) CSS/ACTS

day of Jv11e- , Zo I>

s~ 127 TIMBERHILL PL

CHAPEL HILL NC 27514

II lij lll~llliHil~!ij~j~~llllllll tl Jl) 111111111111

NORTH CAROLINA OF HEALTH NC VITAL RECORDS

CERTIFICATE OF LIVE BIRTH 20140310200038490 BIRTH Bk:B87 Pg:1987

. FACILITY NAME (If not institution, give street anrJ number)

Hospital

FATHER'S CURRENT LEGAL NAME (First, MirJrJie, Lost, Suffix)

(First, MirJrJ/e, Last, Suffix)

MORALES RODRIGUEZ * MOTHER'S NAME PRIOR TO FIRST MARRIAGE (First, MidrJ/e, Last, Suffix)

*INGRID ***** MORALES RODRIGUEZ * 10a. RESIDENCE OF MOTHER· SMTE

North Carolina

10d. STREET AND NUMBER

514 South 6Th Avenue Apt D

10b. COUNTY

Chatham

11. MOTHER'S MAILING ADDRESS: 1!1 Same as residence, or: Stale:

17. FATHER'S RACE (Race[s] father considers himself to be)

•••••

18. MOTHER'S RACE (Raco[s] mothor conslrJors herself to be)

Hispanic

03/10/2014 04:33:37 PM 111

4.SEX

Male

9d. BIRTHPLACE (State, Te"ffory. or Foreign Country)

Mexico

1 Oc. CITY, TOWN, OR LOCATION

Siler City 10e. ZIP CODE

27344 City, Town, or Location:

13. DATE CERTIFIED

__ Q_~ ____ ,.!l4 .. _.,.~.9J~----·· MM DD YYYY

16. DATE

Zip Code:

INSIDE CITY LIMITS?

1!1 Yes D No

4. DA REC'D BY LOCAL REGISTRAR

03 10 2014 ... 'MM _____ ,.oo_ .. ,..yy-.yy·-------

NORTH CARO ..... _ • .JA DEPARTMENT OF HEALTH AND HUM._. SERVICES STATE CENTER FOR HEALTH STATISTICS - VITAL RECORDS SECTION

AFFIDAVIT OF PARENTAGE FOR CHILD BORN OUT OF WEDLOCK (Type or print all information)

We hereby affirm that MATTHEW ABRAHAM LOPEZ XXX-XX-9489 (Full Name of Child) (Social Security Number, if Available)

Who was born 03/02/2014 ,in ~C~HA~P~E~L~H~I~L~L~O~RAN~~G~E~---------------------------(Date of Birth) (City, County of Birth)

at UNC HOSPITAL Affidavit signed at CHATHAM COUNTY IVD (Hospital or Institution)(Ifneither,street address) (Hospital,IV-D,Clerk ofCourt,Other)

is the natural child of GERARDO GABRIEL LOPEZ XXX-XX-9171 (Full Name of Father)/(Social Security Number)

(Address) and INGRID MORALESRODRIGUEZ XXX-XX-3428

(Full Maiden Name of Mother)/(Social Security Number) 1300 SOUTHPORT ST SILER CITY.NC 27344-9415

(Address) INFO~~TION CONCERNING THE FATHER

Race ~H~P--~~--~~----~~------------------Birthdate 11/05/1992 (Specify White, Black, Am Indian, etc.) (Month, Day, Year)

Is father of Hispanic origin? ( )Yes ( )No Birthplace (County, State or Foreign Country)

If yes, specify Cuban, Mexican, Puerto Rican, etc. ______________ _ Education ~C\~\c~-~----~--~~--~~

(Highest Grade Completed Elem 1-8; High 9-12; Col 13-17+)

CERTIFICATION OF PARENTS

I acknowledge that I have received and understand the information on page two of this form that explains the purpose and consequences of signing this document, including possible requirements to pay child support.

Mother Father I am the natural mother and the man named above is the I acknowledge that I am the natura/father of the child natura/father of the child named above. I also declare named above. I understand that this Affidavit shall, and affirm that I () was unmarried at the time I became when signed and sworn by both parents, have the same pregnant ()was married to someone other than the above force and effect as a judgment of the court in establ-namedfather when I became pregnant with the above ishing my paternity of the above-named child. named child or when the child was born. (See Instructions, #1)

Signature of Mothers:&~eo.rQ"Lt\~ Signature of Father ____________ _

(and parent, guardian or custodial adult if minor mother)

My commission expires 3 -3- 2,0

Robertneil Torres NOTARY PUBLIC

Harnett County, NC

(and parent, guardian or custodial adult if minor father)

Sworn to and subscribed before me this ________ __ day of (SEAL)

NOTARY PUBLIC

My commission expires ________ __

INSTRUCTIONS ON PAGE TWO

INSTRUCTIONS

If mother was married to someone other than the father named on this Affidavit at the time of conception or birth or between conception and birth of a child, the name of the husband J:l:!1lli be entered as the father on the birth certificate unless the paternity has been otherwise determined. {See General statute 130A-10l(e).}

2 The father and mother must each complete and sign the Affidavit in the presence of a notary public, clerk of court, register of deeds, or military officer authorized to administer oaths and be given a copy of the Affidavit.

3 When completed at birth, this Affidavit must be filed with the birth certificate. Under no circumstances will the birth certificate be delayed in order to complete the Affidavit. When completed and filed with the court at a later date, the Clerk of the Court will provide notice to Vital Records.

Effect of signing the Affidavit of Parentage

Upon signing this form, the declaring father's name will be listed on the birth certificate, except as noted in Instructions #1 above. He will be declared to be the natural father of the child. This admission of paternity may be retracted by either party within 60 days of signing by filing a request with the court. The father's name may then be removed from the birth records if there has been no administrative or judicial proceeding relating to paternity or support for this child. After 60 days, the father's name may not be removed from these documents except by order of the court.

Rights and Responsibilities of Parents

You have the right to declare the paternity by signing this document or you may choose to request genetic testing, consult an attorney, contact Child Support Enforcement, or have a court hearing to determine paternity. A minor has the right to refrain from signing the affidavit without the signature of a parent, guardian, or custodial adult. You, the father and mother, have a right to know your child, the right to seek custody or visitation, as well as the responsibility to support your child. Parental rights of a parent may not be terminated without notice to both parents.

The execution and filing of this affidavit with the registrar does not affect inheritance rights unless it is also filed with the clerk of court in the county where the father or child resides.

DSS-4697 (09/08) CSS/ACTS

,..

NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION

CHATHAM COUNTY ___ CVD __ _

STATE OF NORTH CAROLINA Ex rel.,

IV-D #

INGRID MORALESRODRIGUEZ, Plaintiff AFFIDAVIT

Vs

GERARDO G. LOPEZ, 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 26th day ofMay, 2015.

My commission Expires:

Jan C. Beal

KATHLEEN SCARBOROUGH NOTARY PUBLIC

. ' .c. My Commission Expires 11..05-2017

STATE OF NORTH CAROLINA COUNTY OF CHATHAM FILE NO.

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 compla1nt 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 21st day of May, 2015.

CHILD SUPPORT AGENT

sworn to and subscribed before me this the 21st day of May, 2015.

~=RY===~---My commission exp1res: KATHLEEN SCARBOROUGH

NOTARY PUBLIC CHATHAM COUNTY, N.C.

My Commission Expires 11-05-2017

· XXX County Clerk of Superior Court CIVIL RECEIPTING

P ayor Name: ~~l&T\e&t C_o. (J~ ~5CVJ) ~'{ {_ (Party to Case) FILE NUMBER

Payee Name:

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

Flag for VCAJ;» =YES Flag for VCAP =NO FILING FEES: (original/counterclaim/cross-claim) FILING FEES:

c ·D DC- it ~d-5· 00 8{VSC Superior $ 200.00 0 VDC District $ 150.00

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

'--JUDGMENT ABSTRACTING JMT JUDGMENT IN DOCKET BOOK - - --

Book Page SERVICE FEES: SERVICE FEES:

0 WRIT OF EXECUTION 21430 $ 0 WR.IT OF EXECUTION 21400 $ 0 WRIT OF POSSESSION 21430 $ 0 WRIT OF POSSESSION 21400 $ D SHERIFF 22515 $ D SHERIFF 22515 $

JUDGMENT PAYMENT: JUDGMENT PAYMENT:

0 Full 0 Patiial 0 Full 0 Partial

D JUDGMENT 26115 $ D JUDGMENT 26120 $ 0 ATTYFEE JUDGMENT 24610 $ 0 BOND FORFEITURE 22800 $ 0 A TTY APPT FEE JUDG 26115$ (PRIOR TO JUDGMENT) 0 BOND FORFEITURE 22800 $ 0 BOND FORF COST 26115 $ 0 ARBITRATION (JA) M#S 26115 $ 0 TRANSCRlPT FEE 21400 $

0 TRANSCRIPT FEE Transcript #

21440 $ County 0 'SUPPL PROCEEDING 21400 $ B 3UPPL PROCEEDI~JG 21400..$ 0 MOT~ FEE N.D.tt. 21450 $ D A&P/ENDORSEMENTS 21455 $ D~~s)+ Pa-LfcJJiecl/.Q/.QlJO Re.n+-q ~l.Q ;:A:lO 'Su.rp\ £AS FL-Vv~ S

-· MISCELLANEOUS FEES: MISCELLANEOUS FEES:

0 MISC FILING FEE' 21435 $ 0 MISC FlUNG FEE 21400 $ (CLOL,LISP.LIENS) 0 COPY 21410 $ 0COPY 21410 $ D CIVIL BONDS 26210 $ 0 CONFESS JUDGMENT 21400 $ 0 CONDEMNATION 26130 $ 0 TRIAL DE NOVO 24310 $ 0 TRUST (Minor's portion) 26310 $ 0 CIVIL BONDS 26210 $ 0 ARBITR.A TION FEES 24311 $ 0 OUT OF STATE ATTY 24625 $ (CVD- BEFORE JUDGMENT)

($200) 0 VSA, REGISTRATION, PASS-0 OUT OF STATE•ATTY 24626$ PORTS, ETC. 21400 $

BAR FEE ($25) D LIS PENDENS 21400 $ D $

·- 0 UPSET BID 26700 $ -----OTHER ACCOUNT-"#

:Pt.~xge J-42'1 ( 0 -DATE:

~ ~'{:- ts-TOTAL: /-5-{) I

c}D -

-

-

-

lATHAM COUt-ITY CLERK OF COURT

Ot./08i15 11:11:59

PAYOR: CHATHAM CO DSS PAYEE: CASEI!: 15CVD000382 VCAf' :i CIT AI!:

21220 DC-CIVIL FEES 21221 [!C-CV LM FEES 24681 JUD TECH & FAC 27'.:..20 CO FAC FEE D CV

TOTAL PAID CO TENDERED

CHANGE

1086 ID ClSKCB -

127.55 2.45 4. 8S

16 .:JD

15D.OO 150.(}!]