File No. STATE OF NORTH CAROLINA Additional File Nos. County In The General Court Of Justice District Superior Court Division STATE VERSUS Name And Address Of Defendant NOTICE OF HEARING ON VIOLATION OF UNSUPERVISED PROBATION G.S. 15A-1345, 143B-262.4 Race Sex Date Of Judgment Date Of Birth Social Security No. Length Of Term Of Unsupervised Probation Sentencing Judge Defendant's Drivers License No. Length Of Sentence Name Of Complainant, If Any (Name, Address Or Department, Phone No.) State Offense(s) VIOLATIONS TO THE DEFENDANT NAMED ABOVE: You were placed on unsupervised probation pursuant to the judgment referred to above, which was entered in this case on the date shown. I, the undersigned, find that there is probable cause to believe that you violated: 1. The condition of your unsupervised probation that you pay to the Clerk of Superior Court the costs of court and any additional sums set forth in that judgment, in that you failed to make in full and when due one or more required payments, with the result that you are in arrears as of this date as follows: Original Obligation Other Costs Paid To Date Arrearage To Date Total Balance Due $ $ $ $ $ 2. The condition of your unsupervised probation that you complete the number of hours of community service specified in that judgment in that you failed within the time provided to a. complete that service as directed by the judicial service coordinator. Hours Required Hours Completed To Date Hours Due b. pay the community service fee prescribed by law. 3. The condition of your unsupervised probation that you obtain a substance abuse assessment from a licensed facility and pay the fee prescribed by law, in that you failed, within the prescribed time, to a. obtain an assessment. b. pay the prescribed fee. 4. The condition of your unsupervised probation that you participate in a treatment program and pay all treatment fees prescribed by law, in that you failed to a. participate in a treatment program, as recommended in your treatment report, for the period provided in that report. b. pay all treatment fees prescribed by law. 5. The condition of your unsupervised probation that you complete an Alcohol and Drug Education Traffic School and pay the fee prescribed by law, in that you failed to a. complete an ADET School as required by G.S. 122C-142.1(c). b. pay the fee prescribed by law. AOC-CR-220, Rev. 4/11 © 2011 Administrative Office of the Courts Original - File Copy - Defendant (Over) American LegalNet, Inc. www.FormsWorkFlow.com 6. The condition of your special probation that you serve an active term of days months in the custody of the sheriff of this county, in that you failed to report as required on date(s) . 7. Other: (specify) This Notice is issued upon information supplied under oath by the complainant listed on reverse, if any, or by the Court's own motion. NOTICE OF HEARING PLEASE TAKE NOTICE THAT a hearing will be held on the violation(s) set forth above on the date, and at the time and location specified below. If the Court finds that you have violated a condition of your unsupervised probation, the Court may revoke your unsupervised probation and order you to begin serving an active sentence. Whether or not the Court finds that you have violated a condition of unsupervised probation, it may continue you on probation, modify the conditions of your probation, and extend the term of your probation. If you were ordered to perform community service work as a condition of probation imposed upon conviction of an offense not involving impaired driving, the court will revoke your drivers license if it finds that you willfully failed to comply with the community service requirements, and will do so whether or not you appear at the hearing. G.S. 143B-262.4(f). If you were ordered to perform community service work as a condition of probation imposed upon conviction for impaired driving under G.S. 20-138.1, the court will revoke your limited driving privilege if it finds that you willfully failed to comply with the community service requirements, and will do so whether or not you appear at the hearing. G.S. 20-179.3(j1) (G.S. 20-179.4 for offenses committed prior to December 1, 2009) and 143B-262.4. (Check one option) If you fail to appear for this hearing, the Court may issue an order requiring you to show cause why you should not be held in contempt of court. In addition, the Court may issue an order for arrest for your failure to appear. An Order For Arrest has been issued and is attached. Date Of Hearing Time Of Hearing Location Of Hearing AM PM Date Signature Name (Type Or Print) Judge CSC Assistant CSC Deputy CSC Magistrate CSWP RETURN OF SERVICE I certify that this Notice Of Hearing On Violation Of Unsupervised Probation was received and served as follows: Date Received Date Served Date Of Mailing By personally serving this Notice Of Hearing On Violation Of Unsupervised Probation on the defendant. By mailing this Notice Of Hearing On Violation Of Unsupervised Probation to the last known address available to the undersigned on the date of mailing shown above. This Notice Of Hearing On Violation Of Unsupervised Probation WAS NOT served for the following reason: Date Of Return Signature AOC-CR-220, Side Two, Rev. 4/11 © 2011 Administrative Office of the Courts Department Or Agency American LegalNet, Inc. www.FormsWorkFlow.com