(TYPE OR PRINT IN BLACK INK) AFFIDAVIT TO OBTAIN STATE OF NORTH CAROLINA ADMINISTRATIVE INSPECTION In The General Court Of Justice WARRANT FOR PARTICULAR County CONDITION OR ACTIVITY I, , being (name and position) duly sworn and examined under oath, state under oath that there is probable cause for believing that there is (describe condition, object, activity, or circumstance which the search is intended to check or reveal)at the property owned or possessed by and described as follows: (precisely describe the property to be inspected) The facts which establish probable cause to believe this are: Signature Of Applicant Name Of Applicant (Type Or Print) SWORN AND SUBSCRIBED TO BEFORE ME: Date Signature Deputy CSC Assistant CSC Clerk Of Superior Court Magistrate District Court Judge Superior Court Judge IMPORTANT: Attach the Affidavit to the WARRANT if not on reverse side. AOC-CR-913M, Rev. 7/01 (Over) 2001 Administrative Office of the Courts >>>> 2 (TYPE OR PRINT IN BLACK INK) STATE OF NORTH CAROLINA ADMINISTRATIVE INSPECTION In The General Court Of Justice WARRANT FOR PARTICULAR CONDITION OR ACTIVITY County G.S. 15-27.2; 58-79-1 TO ANY LAWFUL OFFICIAL EMPOWERED TO CONDUCT THE INSPECTION AUTHORIZED BY THIS WARRANT: The applicant named on the accompanying affidavit, which is hereby incorporated by reference, being duly sworn, has stated to me that there is a condition, object, activity, or circumstance legally justifying an inspection of the property described in that affidavit. I have examined this applicant under oath or affirmation and have verified the accuracy of the matters in the affidavit establishing the legal grounds for this Warrant. YOU ARE HEREBY COMMANDED TO INSPECT THE PROPERTY DESCRIBED IN THE ACCOMPANYING AFFIDAVIT. This inspection is authorized to check or reveal the conditions, objects, activities, or circumstances indicated in the accompanying affidavit. This Warrant must be served upon the owner or possessor of the property described in the accompanying affidavit. If the owner or possessor is not present on the property at the time of inspection and you have made reasonable but unsuccessful efforts to locate the owner or possessor, you may instead serve it by affixing this Warrant or a copy to the property. THIS WARRANT MAY BE EXECUTED ONLY BETWEEN THE HOURS OF 8:00 A.M. AND 8:00 P.M. AND ONLY WITHIN 24 HOURS AFTER IT WAS ISSUED. IT MUST BE RETURNED WITHIN 48 HOURS AFTER IT WAS ISSUED. HOWEVER, IF THIS WARRANT IS ISSUED PURSUANT TO A FIRE INVESTIGATION AUTHORIZED BY G.S. 58-79-1, IT MAY BE EXECUTED AT ANY TIME WITHIN 48 HOURS AFTER IT IS ISSUED. IT MUST BE RETURNED WITHOUT UNNECESSARY DELAY AFTER ITS EXECUTION OR AFTER 48 HOURS FROM THE TIME IT WAS ISSUED IF IT WAS NOT EXECUTED. Date Time AM PM Signature Deputy CSC Assistant CSC Clerk Of Superior Court Magistrate District Court Judge Superior Court Judge OFFICERS RETURN I certify that this WARRANT was executed on the date and time shown below. Date Of Execution Signature Of Inspecting Official Time Of Execution Name Of Inspecting Official (Type Or Print) AM PM CLERKS ACCEPTANCE This WARRANT has been returned to this office on the date and time shown below. Date Of Return Signature Time Of Return AM PM Deputy CSC Assistant CSC Clerk Of Superior Court IMPORTANT: Attach the Affidavit to the WARRANT if not on reverse side. AOC-CR-913M, Side Two, Rev. 7/01 2001 Administrative Office of the Courts