COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : IndexFile No. No. STATE OF NORTH CAROLINA : County STATE VERSUS Superior Court Division Plaintiff(s) Defendant -againstDate Of Offense In No. Calendar The General Court Of Justice : JUDICIAL SUBPOENA INDICTMENT : HABITUAL IMPAIRED DRIVING Offense In Violation Of G.S. 20-138.5 : I. 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 drive a vehicle on a street or highway, public vehicular area, while subject to an impairing substance. Defendant(s) : ...................................................... II. 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 within seven (7) ten (10) (use for habitual impaired driving offenses committed on or after 12/1/06) years of the date of this offense, has been convicted of three (3) or more offenses involving impaired THE follows: driving asPEOPLE OF THE STATE OF NEW YORK Date Of Offense Offense TO Date Of Conviction County/State Court District Superior District Superior District Superior GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before DistrictCourt Superior , the Honorable at the located at County of Superior in room , on the day of , 20 , at Districto'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the District Superior Signature Of Prosecutor Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a WITNESSES result of your failure to comply. Court in Witness, Honorable County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) The Witnesses marked "X" were sworn by the undersigned Foreperson of the Grand Jury and, after hearing testimony, this Bill was found to be: Attorney(s) for A TRUE BILL by twelve or more grand jurors, and I, the undersigned Foreperson of the Grand Jury, attest the concurrence of twelve or more grand jurors in this Bill of Indictment. NOT A TRUE BILL. Office and P.O. Address Date AOC-CR-154, Rev. 12/06 © 2006 Administrative Office of the Courts Signature Of Grand Jury Foreperson Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.FormsWorkflow.com