AUTHORIZATION DOCKET NO.

 

AUTHORIZATION DOCKET NO.

I, _________________, hereby authorize my attorney, ________________________,
to pay my civil revocation fee to the ______________ County Clerk of Court and obtain my
driver's license.


This is the ___________________, day of ________________, 20_____.


________________________
Defendant's Signature

 


__________________County
State of North Carolina


I certify that the following person(s) personally appeared before me this day, each acknowledging to
me that he/she voluntarily signed foregoing document for the purpose stated therin and in the capacity
indicated __________________________, name (s) of principle(s))
Date ________________________________ ____________________________________
Notary Public
My Commission Expires: ______________
(Official Seal)

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