File No. STATE OF NORTH CAROLINA In The General Court Of Justice Superior Court Division County STATE VERSUS INDICTMENT FELONY ESCAPE FROM CONFINES OF STATE PRISON UNIT (4914) Name Of Defendant Date Of Offense Offense In Violation Of G.S. Date Sentence Imposed County Where Sentence Imposed 148-45(b)(1) Court In Which Sentence Imposed District Superior The jurors for the State upon their oath present that on or about the date of offense shown and in the county named above the defendant named above unlawfully, willfully and feloniously did escape and attempt to escape from a unit of the State prison system, while the defendant was there in lawful custody of the Department of Correction serving a sentence for conviction of a felony, that sentence having been imposed on the date and in the county and court indicated above. NOTE This Indictment only charges an escape from the prison confines by a convicted felon serving a sentence in the State prison system, G.S. 148-45(b)(1). Signature Of Prosecutor WITNESSES The Witnesses marked "X" were sworn by the undersigned Foreman of the Grand Jury and, after hearing testimony, this Bill was found to be: A TRUE BILL by twelve or more grand jurors, and I the undersigned Foreman of the Grand Jury, attest the concurrence of twelve or more grand jurors in this Bill of Indictment. NOT A TRUE BILL. Date Signature Of Grand Jury Foreman AOC-CR-132, Rev. 10/96 1997 Administrative Office of the American LegalNet, Inc. www.USCourtForms.com