COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .. .. STATE. OF .NORTH CAROLINA : File No. Index No. : STATE VERSUS Name Of Defendant Plaintiff(s) In The General Court Of Justice Calendar No. District Superior Court Division : County JUDICIAL SUBPOENA WAIVER OF EXTRADITION : FINDINGS AND ORDER -against- G.S. 15A-746 : Name Of Prosecutor Name Of Defendant's Attorney Waived : Crime(s) In Demanding State Defendant(s) : ...................................................... Date Of Crime Name Of Demanding State And County Of Crime WAIVER OF THE PEOPLE OF THE STATE OF NEW YORK DEFENDANT I, the undersigned, in open court state that: 1. TO a. I understand that I have been arrested in this State under criminal process alleging that I committed the crime(s) shown above on the date and in the demanding state and county named above. b. I understand that I have been arrested in this State under criminal process alleging that I was convicted of the GREETINGS: above, which was committed on the date of offense and in the demanding state and county crime(s) shown named above, and further alleging that I have escaped from confinement or broken the terms of my bail, WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before probation or parole. , the Honorable at the Court located at County of 2. A Judge or a Clerk of Superior Court has informed me that I am not required to sign this Waiver and that I have a on the day of 20 , other stages of extradition. noon, judicialany recessed o'clock in the right in room to be represented, by an attorney before signing it ,and at allat This and at official also or adjourned if I do not sign this Waiver, I cannot witness in this the demanding state until a Governor's Warrant informed me that date, to testify and give evidence as abe extradited toaction on the part of the has been issued and served on me and if a Governor's Warrant is served on me, I will have a right to apply for a writ of habeas corpus. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 3. I freely and voluntarily waive the issuance and service of a Governor's Warrant and all other procedure incidental to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a extradition proceedings. result of your failure to comply. 4. I freely and voluntarily consent to return to the demanding state shown above upon the arrival of a duly accredited Witness, Honorable , one of the Justices of the agent of that state. Court in County, day of Date , 20 Signature Of Defendant FINDINGS AND ORDER (Attorney must sign above and type name below) I am a Judge or Clerk of Superior Court of the General Court of Justice of North Carolina, a court of record. The defendant named above appeared before me this day. I informed the defendant of the right to the issuance and service of a Governor's Warrant and to obtain a writ of habeas corpus as provided for in N. C. G.S. 15A-730. The defendant Attorney(s) for then freely, voluntarily and understandingly executed the above Waiver in my presence. To any officer having the defendant named above in custody: You are DIRECTED to deliver the defendant together with a copy of this document, to Address accredited agent(s) of the Office and P.O. the duly demanding state upon their presentation of evidence of their accreditation. Date Signature Name (Type Or Print) AOC-CR-912M, Rev. 7/2000 2000 Administrative Office of the Courts Telephone No.: Facsimile No.: Superior Court Judge E-Mail Address: Clerk Of Superior Court Mobile Tel. No.: Original-File Copy-Sheriff Copy-Governor District Court Judge Assistant CSC Copy-Defendant American LegalNet, Inc. www.USCourtForms.com