File No. STATE OF NORTH CAROLINA In The General Court Of Justice Superior Court Division County STATE VERSUS INDICTMENT Name Of Defendant Date Of Offense Offense In Violation Of G.S. 148-45(b); 148-45(g)(1) Date Sentence Imposed FELONY ESCAPE FROM STATE PRISON SYSTEM BY FAILING TO RETURN AFTER AUTHORIZED ABSENCE (4914) County Where Sentence Imposed Court In Which Sentence Imposed District Superior The jurors for the State upon their oath present that on or about the date of offense shown and in the county named above the defendant named above unlawfully, willfully and feloniously did escape and attempt to escape from , a unit of the State prison system, while the defendant was there in the lawful custody of the Department of Correction serving a sentence for conviction of a felony, that sentence having been imposed on the date and in the county and court indicated above. The defendant escaped and attempted to escape while on by willfully failing to return to the custody of the Department of Correction at the the appointed place and appointed time as ordered. NOTE: This indictment only charges an escape while on temporary custody release, such as the work-release program, by a convicted felon serving a sentence in the State prison system, G.S. 148-45(b)(1) and G.S. 148-45(g)(1). Signature Of Prosecutor WITNESSES The Witnesses marked "X" were sworn by the undersigned Foreman of the Grand Jury and, after hearing testimony, this Bill was found to be: A TRUE BILL by twelve or more grand jurors, and I the undersigned Foreman of the Grand Jury, attest the concurrence of twelve or more grand jurors in this Bill of Indictment. NOT A TRUE BILL. Date Signature Of Grand Jury Foreman AOC-CR-131, Rev. 10/96 1997 Administrative Office of the Courts American LegalNet, Inc. www.USCourtForms.com