FORM GOV. 2-A, Rev. 10/99 1999 Administrative Office of the Courts STATE OF NORTH CAROLINA STATE OF NORTH CAROLINA CERTIFICATE COUNTY OF I, , Clerk of the Superior Court of County, North Carolina, a court of record, do hereby certify: 1. That District Attorney Assistant District Attorney of the Prosecutorial District of North Carolina; and that the attached application for the requisition of has been signed by above named District Attorney/Assistant District Attorney as aforesaid; 2. That the attached copy of the (a) Warrant and Affidavit is a true and correct copy issued on , ; OR (b) The indictment is a true and correct copy of an indictment against the subject, found to be a true bill on the day of , by the grand jurors of the State of North Carolina in and for the County of , attending the Superior Court of the said county; that the indictment is now pending against the said ; and that the original indictment is on file in my office. 3. That the attached copy of a judgment of conviction and sentence is a true and correct copy of a judgment rendered against the subject in the Court of County on the day of , ; and that the original judgment is on file in my office. 4. That the Warrant or Indictment, Judgment and Probation Violation Report and Order for Arrest hereto attached are true and correct copies of same. That the original Warrant was duly issued on the day of , by , duly appointed, qualified and acting Magistrate, Proper Official, . That the Judgment was duly signed on the day of , , by , presiding Judge of the District Court District Superior Court District of North Carolina, embracing the County of . That the Probation Violation Report and Order for Arrest was duly signed on the day of , by , presiding Judge of the District Court District Superior Court District of North Carolina, embracing the County of . That the Order for Arrest was duly issued on the day of , by , Clerk of Superior Court of County, North Carolina. That the original Warrant or Indictment, Judgment, Probation Violation Report and Order for Arrest are on file in my office, and that said probation violation is now pending against the said . IN WITNESS WHEREOF, I have set my hand and official seal of my said office, this the day of , . (Seal of Court) Clerk Of Superior Court County, North Carolina This form to be used by the (Assistant) District Attorney in certification of the documents and his/her signature on the Application for Requisition of Escapees; Violators of Probation; and Bail. Select #2 and #3 for Application for Requisition of Escapees and Bail Violators. Select #4 for Application for Requisition of Violators of Probation. Certifications to be attached to (Assistant) District Attorneys Application for Requisition of Escapees; Violators of Bail and Probation.