STATE OF NORTH CAROLINA County NOTE: File No. In The General Court Of Justice District Superior Court Division Seat Of Court (Applies to a Class H or I felony or a Misdemeanor) STATE VERSUS MOTION/AGREEMENT AND ORDER TO DEFER PROSECUTION (STRUCTURED SENTENCING) Defendant Race Sex DOB G.S. 15A-1341(a1) Social Security No. Attorney For State Def. Waived Attorney Def. Found Not Indigent Attorney For Defendant Defendant's Drivers License No. Appointed Retained The defendant, attorney for the defendant, and undersigned Prosecutor, request the Court to approve this Agreement to defer prosecution and place the defendant on probation on the following offense(s): File No.(s) Off. Offense Description Offense Date G.S. No. F/M CL. Max Term CONDITIONS OF AGREEMENT TO DEFER PROSECUTION With approval of the Court and consent of the defendant, prosecution will be deferred by the prosecutor for the purpose of allowing the defendant to demonstrate good conduct, and subject to the conditions set out below, the defendant is placed on: unsupervised probation for months. supervised probation for months. 1. The defendant abide by the rules and regulations for regular conditions of probation that are applicable to (a) unsupervised probation (b) supervised probation and which are more fully set forth on AOC-CR-603 AOC-CR-604 and incorporated herein by reference. AOC-CR-603 2. The defendant abide by the following Special Conditions of Probation that are more fully set forth on AOC-CR-604 and incorporated herein by reference: and/or other Special Conditions: 3. The defendant shall complete hours of Community or Reparation Service during the first days of deferral period, as directed by the Community Service Staff and pay the fee prescribed by G.S. 143B-262.4(b) as directed by Community Service Staff. All fees are paid to the Clerk of Superior Court. 4. The defendant shall pay to the Clerk of Superior Court the "Total Amount Due" shown below, plus the probation supervision fee, pursuant to a schedule determined by the probation officer. set out by the court as follows: Fine Court Costs Restitution* Attorney's Fee Community Service Fee Total Amount Due $ $ $ $ $ $ *See attached "Restitution Worksheet, Notice And Order (Initial Sentencing)," AOC-CR-611, which is incorporated by reference. 5. The admission of responsibility given by me and any stipulation of facts shall be used against me and admitted into evidence without objection in the State's prosecution against me for this offense should prosecution become necessary as a result of these terms and conditions of deferred prosecution. 6. Regular reports will be made on my progress to the prosecutor's office. 7. The prosecutor will take a voluntary dismissal with leave upon approval of this Agreement by the Court. take a voluntary dismissal upon compliance with this Agreement. AOC-CR-610, Rev. 4/08 © 2008 Administrative Office of the Courts Material opposite unmarked squares is to be disregarded as surplusage. (Over) American LegalNet, Inc. www.FormsWorkFlow.com DEFENDANT'S OATH/AGREEMENT/MOTION The defendant after being duly sworn, states under oath: 1. I have not been previously convicted of any felony or of any misdemeanor involving moral turpitude. 2. I have not been previously placed on probation. 3. I hereby waive all of my rights to a speedy trial under the constitution and laws of the State of North Carolina and the United States of America with regard to the above listed charge(s). 4. I have reviewed a copy of this Motion/Agreement And Order To Defer Prosecution and all of the conditions of my probation and I agree to them, and request the Court to approve the agreement. 5. I understand that no person who supervises me or for whom I work while performing community or reparation service is liable to me for any loss or damage which I may sustain unless my injury is caused by that person's gross negligence or intentional wrongdoing. SWORN AND SUBSCRIBED TO BEFORE ME Date Date Signature Signature Of Defendant (under oath) Deputy CSC Assistant CSC District Court Judge Superior Court Judge Clerk Of Superior Court ATTORNEYS' CERTIFICATION/AGREEMENT/MOTION The undersigned attorneys certify to the Court that each known victim of the crime has been notified of the motion for probation by subpoena or certified mail and has been given an opportunity to be heard and the undersigned request the Court to approve the agreement. Date Signature Of Lawyer For Defendant Signature Of Prosecutor FINDINGS Based upon the foregoing and a review of the record, the Court finds: 1. Prosecution has been deferred by the prosecutor pursuant to written agreement with the defendant, with the approval of the court, for the purpose of allowing the defendant to demonstrate good conduct. 2. Each known victim of the crime has been notified of the motion to defer prosecution and place the defendant on probation and has been given an opportunity to be heard. 3. The defendant has not been convicted of any felony or of any misdemeanor involving moral turpitude. 4. The defendant has not previously been placed on probation and so states under oath. 5. The defendant is unlikely to commit another offense other than a Class 3 misdemeanor. ORDER THE COURT HAVING CONSIDERED the Motion and Agreement to Defer Prosecution, related documents and statements of counsel, finds that the prosecutor and defendant have entered into a written agreement to defer prosecution in this case for a period not to exceed two years, and said Motion and Agreement is in compliance with the conditions set forth in G.S. 15A-1341(a1) and specified in the motion. IT IS ORDERED that the Agreement to Defer Prosecution in this case is approved and all conditions of this Agreement as specified above are adopted by the Court and made part of this Order. The defendant is to comply with all the regular conditions of probation including the special conditions as set forth above. IT IS FURTHER ORDERED that the defendant's present conditions of release shall remain in full force and effect until final disposition of this matter. THE ABOVE CASE(S) IS ORDERED CONTINUED to allow the defendant to satisfactorily comply with this Agreement from this date until (date) . SIGNATURE OF JUDGE Date Name Of Presiding Judge (Type Or Print) Signature Of Presiding Judge CERTIFICATION I certify that this Motion/Agreement And Order To Defer Prosecution is a true copy of the original. Date Of Certification Signature And Seal Deputy CSC Assistant CSC Clerk Of Superior Court AOC-CR-610, Side Two, Rev. 4/08 © 2008 Administrative Office of the Courts Material opposite unmarked squares is to be disregarded as surplusage. American LegalNet, Inc. www.FormsWorkFlow.com File No. STATE VERSUS Name Of Defendant ADDITIONAL FILE NO.(S) AND OFFENSE(S) File No.(s) Off. Offense Description Offense Date G.S. No. F/M CL. *NOTE: Enter punishment class if different from underlying offense class (punishment class represents a status or enhancement). AOC-CR-603, Page Three, Rev. 3/09, © 2009 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com *Pun. CL.