27 CAR § 30-157. Form of the affidavit

Any affidavit filed for reinstatement of driving and/or registration privilege shall include, but shall not be limited to the following items: (1) Date and location of accident; (2) Effective date of suspension; and (3) Statement that one (1) year has elapsed following the date of suspension and that during such period no action at law upon such agreement has been instituted and is pending.