en-USFile No. en-USSTATE OF NORTH CAROLINAen-US en-US Countyen-USIn The General Court Of Justiceen-USDistrict Court Division en-USSTATE VERSUSen-USName And Address Of Defendanten-USDate Of Offenseen-USAmount Of Fineen-US$en-US$en-US$en-US$en-USName(s) And Address(es) Of Person(s) To Receive Restitutionen-USDateen-USSignature Of Defendanten-USCourt Costsen-USRestitution (if applicable)en-USTotalen-USen-USCourt Dateen-USOffense(s)en-USWAIVER OF TRIALen-USPLEA OF GUILTYen-USCONSENT TO ENTRY OF JUDGMENTen-US(MISDEMEANORS)en-USG.S. 7A-146, -148, -180, -273; 15A-1011en-USI acknowledge that I have been charged with the offense noted above by the charging officer or complainant indicated on the criminal en-USprocess in this case. en-USI understand that I am presumed by law to be Not Guilty until proven Guilty beyond a reasonable doubt. Nevertheless, I do hereby waive en-USmy constitutional rights to a trial in open court, to confront the witnesses against me, and to representation by an attorney.en-USI hereby plead Guilty to the offense and tender to the Court the sums listed below as payment of the fine, costs, and restitution, if en-USapplicable in this case.en-USI request that the Court accept my waiver of trial, plea of Guilty and tender of fine, costs (and restitution), and that a final judgment of en-USGuilty be entered. This request is made with the full understanding that a verdict of Guilty will be entered against my record, that if this is en-USa motor vehicle offense, the North Carolina Division of Motor Vehicles (or the licensing authority of any other State that issued my license en-USto drive) will be notified of the verdict, that it will have the same legal effect for all purposes as a verdict of Guilty after a trial, and that it en-USmay result in the assessment of points on my driving and insurance records or the suspension or revocation of my drivers license. en-US(Waiver Of Hearing Infractions on reverse)en-USOriginal - File American LegalNet, Inc. www.FormsWorkFlow.com en-USFile No. en-USSTATE OF NORTH CAROLINAen-US en-US Countyen-USIn The General Court Of Justiceen-USDistrict Court Division en-USSTATE VERSUSen-USName And Address Of Defendanten-USDate Of Infractionen-USAmount Of Penaltyen-US$en-US$en-USCourt Costsen-USCourt Dateen-USInfraction(s)en-USWAIVER OF HEARINGen-USADMISSION AND CONSENT TOen-USFINDING OF RESPONSIBILITYen-US(INFRACTIONS)en-USG.S. 7A-146, -148, -180, -273; 15A-1011en-USI acknowledge that I have been charged with the infraction noted above by the charging officer or complainant indicated on the process en-USin this case. en-USI understand that I am presumed by law to be Not Responsible until proven Responsible beyond a reasonable doubt. Nevertheless, I en-USdo hereby waive my constitutional rights to a hearing in open court, to confront the witnesses against me, and to representation by an en-USattorney.en-USI hereby admit Responsibility to the infraction and tender to the Court the sums listed below as payment of the penalty and costs in this en-UScase.en-USI request that the Court accept my waiver of hearing, admission of Responsibility and tender of penalty and costs, and that a finding en-USof Responsibility be entered. This request is made with the full understanding that a finding of Responsibility will be entered against en-USmy record, that if this is a motor vehicle infraction, the North Carolina Division of Motor Vehicles (or the licensing authority of any other en-USState that issued my license to drive) will be notified of the finding, that it will have the same legal effect for all purposes as a finding of en-USResponsibility after a hearing, and that it may result in the assessment of points on my driving and insurance records or the suspension or en-USrevocation of my drivers license. en-US$en-USTotalen-US en-USDateen-USSignature Of Person Charged en-US(Waiver Of Trial Misdemeanor Cases on reverse)en-USOriginal - File American LegalNet, Inc. www.FormsWorkFlow.com