FORM GOV. 2-F, Rev. 10/99 1999 Administrative Office of the Courts STATE OF NORTH CAROLINA AFFIDAVIT STATE OF NORTH CAROLINA COUNTY OF This day , personally appeared before me, County, North Carolina, and after first being duly sworn, stated that in the Court for the County (City) of in the State of North Carolina, on the , day of , subject , the , was convicted of , and was sentenced to confinement in the , for a term of , as shown by certified copy of the indictment (or warrant) and judgment attached; that the said subject was accordingly confined in the which he/she escaped on the from day of , , without having completed his/her sentence; and that the said subject is now in the State of and in the custody of . Sworn and subscribed to before me, this the Name And Official Title Of Officer Making Affidavit day of , . Clerk Of Superior Court County, North Carolina Form of affidavit to be made by (Assistant) District Attorney or by officer from whose custody the prisoner escaped. 2001 © American LegalNet, Inc.