Defendant(s) : ...................................................... Law Enforcement Case No. File No. CRIMINAL SUMMONS MISDEMEANOR ASSAULT LID No. THESTATEOF THE STATE OF NEW YORK PEOPLE OF NORTH CAROLINA SID No. FBI No. In The General Court Of Justice District Court Division County IV. On Female TO V. Pointing Gun To the defendant: VI. On Gov't Off./Emp. I, the undersigned, find that there is probable cause to believe that on or about the date of offense shown and in the county named above, you unlawfully and willfully did assault THE STATE OF NORTH CAROLINA VS. (charge only one offense) I. Simple II. Serious Injury III. Deadly Weapon GREETINGS: Name And Address Of Defendant I. SIMPLE ASSAULT [G.S. 14-33(a)] and strike by . WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court by located at County of thereby inflicting serious injury (describe injury) in room , on the day of , 20 , at o'clock in the noon, and at any recessed . The defendant committed this offense witness person with whom the defendant or adjourned date, to testify and give evidence as a against ain this action on the part of the has a personal relationship II. ASSAULT INFLICTING SERIOUS INJURY [G.S. 14-33(c)(1)] and strike County Of Residence as defined in G.S. 50B-1 and in the presence of a minor. [G.S. 14-33(d)] Telephone No. III. ASSAULT WITH A DEADLY WEAPON [G.S. 14-33(c)(1)] Race Sex Social Security No. Date Of Birth with a deadly weapon, a by Age Drivers License No. & State Name Of Defendant's Employer Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to The behalf this subpoena was issued for a a person with whom the defendant damages sustained as a the party on whose defendant committed this offense against maximum penalty of $50 and allhas a personal relationship as defined in G.S. 50B-1 and in the presence of a minor. [G.S. 14-33(d)] result of your failure to comply. IV. ASSAULT ON A FEMALE BY A MALE OVER 18 [G.S. 14-33(c)(2)] and strike , . , a female person, by Offense Code(s) I. 1368 II. 1387, 1350 III. 1388, 1351 Offense In Violation Of G.S. IV. 1389 V. 1322 VI. 1391 Witness, Honorable , one of the Justices of the The defendant is a male person and was at least20 years of age when the offense occurred. 18 Court in County, day of , Date Of Offense V. ASSAULT BY POINTING A GUN [G.S. 14-34] by intentionally , at such person without pointing a gun, legal justification. Complainant (Name, Address Or Department) . (Attorney must sign above and type name below) VI. ASSAULT ON GOVERNMENT OFFICER/EMPLOYEE [G.S. 14-33(c)(4)] and strike County Of Residence , , a government (officer) (employee) . by Attorney(s) for At the time of the offense the (officer) (employee) was attempting to discharge the following duty of his/her (office) . (employment): Telephone No. Names & Addresses Of Witnesses (Including Counties & Telephone Nos.) This act was in violation of the law referred to in this Criminal Summons. This Summons is issued upon information furnished under oath by the complainant listed. You are ORDERED to appear before the Court at the location, date and time indicated below to answer to the charge. If you fail to appear, an order for your arrest may be issued and you may be Office and fined up to $500.00 or both. This penalty for held in CONTEMPT OF COURT and imprisoned for up to thirty (30) days or P.O. Address failure to appear is in addition to any sentence which may be imposed for the crime charged. Signature Misdemeanor Offense Which Requires Fingerprinting Per Fingerprint Plan Date Issued AOC-CR-145, Rev. 12/03 (Structured Sentencing) 2003 Administrative Office of the Courts Location Of Court Magistrate Deputy CSC Assistant CSC Clerk Of Superior Court (Over) Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Court Date Court Time AM PM American LegalNet, Inc. www.USCourtForms.com Defendant(s) : ...................................................... If this Criminal Summons is not served within ninety (90) days, it must be District Attorney returned to the Clerk of Court in the county in which it was issued with the reason for the failure of service noted thereon. The officer must state all steps taken by the department in attempting to serve the Summons and PLEA: guilty any information obtained about the whereabouts of the defendant. THE PEOPLE OF guilty not guilty RETURN OF SERVICE Attorney For Defendant Waived Appointed Retained Not Indigent no contest THE STATE no contest VERDICT: OF NEW YORK PRIOR CONVICTIONS: No./Level: 0 guilty guilty not guilty I (0) II (1-4) M.CL. M.CL. A1 A1 III (5+) 1 1 2 2 3 3 I certify that this Criminal Summons was received and served as JUDGMENT: The defendant appeared in open court and freely, voluntarily and understandingly entered the above plea; on the above TO . pay costs and a fine of $ verdict it is ORDERED that the defendant: follows: days served. Date Returned days in the custody of the sheriff. DOC.* Pretrial credit Date Received Date Served be imprisoned for a term of Work release is recommended. is not recommended. [ is ordered. (use form AOC-CR-602)] The Court finds that a longer shorter period of probation, than that which is specified in G.S. 15A-1343.2(d), is necessary. By personally serving this Criminal Summons on the months, subject Execution of the sentence is suspended and the defendant is placed on unsupervised probation* for GREETINGS: defendant. to the following conditions: (1) commit no criminal offense in any jurisdiction. (2) possess no firearm, explosive or other deadly weapon This Criminal Summons WAS NOT served for the following listed in G.S. 14-269. (3) remain gainfully and suitably employed or faithfully pursue a course of study or of vocational training, that will reason: equip the defendant for suitable employment, and abide by all rules of the institution. (4) satisfy child support and family obligations, as WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before required by the Court. (5) pay to the Clerk the costs of court and any additional sums shown below. , theFine Honorable at the Court Restitution* Attorney's Fee Community Service Fee Other located at County of $ $ $ $ $ in room address(es),on the & social security number(s) of aggrieved party(ies) to receive restitution: the , amount(s) day of , 20 , at o'clock in noon, and at any recessed *Name(s), or adjourned date, to testify and give evidence as a witness in this action on the part of the Signature Of Officer Making Return Department Or Agency Of Officer REDELIVERY/REISSUANCE Date Signature Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 6. on whose hours of community service during a first days of probation, as damages sustained the party complete behalf this subpoena was issued forthe maximum penalty of $50 and all directed by community as a service coordinator, and pay days. result of your failure to comply. the fee prescribed by G.S. 143B-475.1(b) within Dep. CSC Assist. CSC CSC RETURN FOLLOWING REDELIVERY/REISSUANCE I certify that this Criminal Summons was received and served as follows: Date Received Date Served 7. not be found in or on the premises of the complainant or 8. not assault, communicate with or be in the presence of the complainant or 9. Other: Witness, Honorable Date Returned Court in County, day of (Attorney must sign above and type name below) Signature Of Officer Making Return It is ORDERED that this: Attorney(s) for Judgment is continued upon payment of costs. . case be consolidated for judgment with sentence is to run at the expiration of the sentence in Department Or Agency Of Officer The defendant, in open court, gives notice of appeal to the Superior Court. The current pretrial release order is modified as follows: , one of the Justices of the , 20 By personally serving this Criminal Summons on the defendant. This Criminal Summons WAS NOT served for the following reason: APPEAL ENTRIES . . . COMMITMENT: It is ORDERED that the Clerk deliver two certified copies of this Judgment and Commitment to the sheriff and that the sheriff cause the defendant to be retained in custody to serve the sentence imposed or until the defendant shall have complied with the Office and P.O. Address conditions of release pending appeal. Date Name Of District Court Judge (Type Or Print) Signature Of District Court Judge CERTIFICATION Telephone No.: I certify that this Judgment is a true and complete copy of the original which is on file in this case. Date Signature Of District Court Judge Date AOC-CR-145, Side Two, Rev. 12/03 (Structured Sentencing) 2003 Administrative Office of the Courts Facsimile No.: Deputy CSC E-Mail Address: Assist. CSC Mobile Tel. No.: *NOTE: If DWI, use AOC-CR-342 (active) or AOC-CR-310 (probation). If active sentence to DOC, use AOC-CR-602. If supervised Date Delivered To Sheriff Signature CSC probation, use AOC-CR-604. American LegalNet, Inc. www.USCourtForms.com