File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Superior Court Division STATE VERSUS Name Of Defendant FUGITIVE AFFIDAVIT G.S. 15A-733, 15A-734Crime(s) In Demanding State Name, Address And Telephone No. Of Contact Person In Demanding StateDate Of Crime Name Of Demanding State And County Of Crime Title I, the undersigned, state that this Affidavit is based upon 1. criminal process issued by a judicial official of the demanding state, a copy of which is attached. 2. the affidavit of the contact person named above, a copy of which is attached. 3. a NCIC-DCI message from the contact person named above, a copy of which is attached. 4. a telephone message from the contact person named above. 5. Other: On or about the date of offense shown and in the demanding state and county named above the crime named above was committed and the defendant named above is now in the State of North Carolina and has 1. been charged with the commission of that crime and has fled from justice. 2. been convicted of that crime and has escaped from confinement. 3. broken the terms of bail, probation or parole. Date SWORN AND SUBSCRIBED TO BEFORE ME Date Signature Of Affiant Signature Name Of Affiant (Type Or Print) Magistrate District Court Judge Superior Court JudgeTitle Of Person Signing AOC-CR-911M, Rev. 9/98 1998 Administrative Office of the Courts