File No. STATE OF NORTH CAROLINA WARRANT FOR ARREST I. FELONIOUS FINANCIAL TRANSACTION CARD THEFT II. FINANCIAL TRANSACTION CARD FRAUD In The General Court Of Justice District Court Division County To any officer with authority and jurisdiction to execute a warrant for arrest for the offense(s) charged below: (charge one or both as appropriate) Felony Misdemeanor I. FELONIOUS FINANCIAL TRANSACTION CARD THEFT [G.S. 14-113.9(a)(1)] I, the undersigned, find that there is probable cause to believe that on or about the date of offense shown and in the county named above the defendant named above unlawfully, willfully and feloniously did take, obtain and withhold the financial transaction card described below from the person, possession, custody and control of the person named below. The taking, obtaining and withholding was done without the consent of the cardholder named below and with the intent to use the financial transaction card described below. THE STATE OF NORTH CAROLINA VS. Name And Address Of Defendant II. FINANCIAL TRANSACTION CARD FRAUD [G.S. 14-113.13(a)(1)] County Of Residence Telephone No. Race Date Of Birth Sex Social Security No. I. 2612 II. 2616(F), 2605(M) Drivers License No. & State Name Of Cardholder Offense In Violation Of G.S. 14-113.9(a)(1), 113.13(a)(1) Name Of Person From Whom Card Was Taken, Obtained, Or Withheld Date Of Offense Financial Transaction Card Company Date Of Arrest & Check Digit No. (As Shown On Fingerprint Card) Financial Transaction Card No. Name Of Merchant From Whom Goods, Services, Etc. Obtained Complainant (Name, Address Or Department) Goods, Services, Etc. Obtained County Of Residence Value Of Goods, Services, Etc. Obtained During Six-month Period $ Telephone No. Names & Addresses Of Witnesses (Including Counties & Telephone Nos.) This act(s) was in violation of the law(s) referred to in this Warrant. This Warrant is issued upon information furnished under oath by the complainant listed. You are DIRECTED to arrest the defendant and bring the defendant before a judicial official without unnecessary delay to answer the charge(s) above. Signature Date Issued Location Of Court Magistrate Deputy CSC Assistant CSC AOC-CR-142, Rev. 6/97 (Structured Sentencing) 1997 Administrative Office of the Courts Misdemeanor I, the undersigned, find that there is probable cause to believe that on or about the date of offense shown and in the county named above the defendant named above unlawfully, willfully and feloniously did with the intent to defraud use the financial transaction card described below for the purpose of obtaining goods, services and other things of value described below. The financial transaction card was obtained and retained by financial transaction card theft under G.S. 14-113.9. The value of the goods, services and other things of value that were obtained by this violation during a six-month period was as specified below. Age Name Of Defendant's Employer Offense Code(s) Felony (NOTE: This charge is a felony if the value of goods, services, etc. obtained during a six-month period exceeds $500. This charge is a misdemeanor if the goods, services, etc. obtained during a six-month period is $500 or less.) Court Date Court Time Clerk Of Superior Court (Over) American LegalNet, Inc. www.FormsWorkFlow.com AM PM If this Warrant For Arrest is not served within one hundred and eighty (180) days, it must be returned to the Clerk of Court in the county in which it was issued with the reason for the failure of service noted thereon. The officer must state all steps taken by the department in attempting to execute the Warrant and any information obtained about the whereabouts of the defendant. District Attorney Attorney For Defendant At Time Of Trial Or Plea Appointed PRIOR CONVICTIONS: Retained No./Level: 0 I (0) II (1-4) III (5+) Waived PLEA: VERDICT: guilty 2 3 guilty no contest MISD. CLASS: 1 2 3 guilty no contest guilty MISD. CLASS: 1 not guilty not guilty RETURN OF SERVICE I certify that this Warrant was received and served as follows: JUDGMENT: The defendant appeared in open court and freely, voluntarily and understandingly entered the above plea; on the above verdict pay costs and a fine of $ . it is ORDERED that the defendant: Date Received Date Served Date Returned be imprisoned for a term of days in the custody of the sheriff. DOC. Pretrial days Work release is recommended. is not recommended. [ is ordered. (use form AOC-CR-602)] By arresting the defendant and bringing the defendant before: The Court finds that a longer shorter period of probation, than that which is specified in G.S. 15A-1343.2(d), is Name Of Judicial Official With defendant's consent, execution of the sentence is suspended and the defendant is placed on unsupervised probation for months, subject to the following conditions: (1) commit no criminal offense in any jurisdiction. (2) possess no firearm, explosive or other deadly weapon listed in G.S. 14-269. (3) remain gainfully and suitably employed or faithfully pursue a This Warrant WAS NOT served for the following reason: course of study or of vocational training, that will equip the defendant for suitable employment, and abide by all rules of the institution. (4) satisfy child support and family obligations, as required by the Court. (5) pay to the Clerk the costs of court and Signature Of Officer Making Return any additional sums shown below. Fine Restitution* Attorney's Fee Community Service Fee Other $ Department Or Agency Of Officer $ $ $ $ *Name(s), address(es), amount(s) & social security number(s) of aggrieved party(ies) to receive restitution: REDELIVERY Date Signature Dep. CSC Assist. CSC CSC RETURN FOLLOWING REDELIVERY I certify that this Warrant was received and served as follows: Date Received Date Served Date Returned By arresting the defendant and bringing the defendant before: Name Of Judicial Official 6. complete hours of community service during the days of probation, as directed by the service coordinator, and pay the fee prescribed by G.S. 143B-475.1(b) 7. not be found in or on the premises of the complainant 8. not assault, communicate with or be in the presence of the complainant or 9. Other days. This Warrant WAS NOT served for the following reason: Signature Of Officer Making Return Department Or Agency Of Officer APPEAL ENTRIES The defendant, in open court, gives notice of appeal to the Superior Court. The current pretrial release order is modified as follows: Date Signature Of District Court Judge WAIVER OF PROBABLE CAUSE HEARING The undersigned defendant, with the consent of his/her attorney, waives the right to a probable cause hearing. Date Waived Signature Of Defendant It is ORDERED that this: Judgment is continued upon payment of costs. case be consolidated for judgment with sentence is to run at the expiration of the sentence in COMMITMENT: It is ORDERED that the Clerk deliver two certified copies of this Judgment and Commitment to the sheriff and that the sheriff cause the defendant to be retained in custody to serve the sentence imposed or until the defendant shall have complied with the conditions of release pending appeal. PROBABLE CAUSE: Probable cause is found as to all Counts except , and the defendant is bound over to Superior Court for action by the grand jury. No probable cause is found as to Count(s) of this Warrant, and the Count(s) is Date Name Of District Court Judge (Type Or Print) Signature Of District Court Judge CERTIFICATION I certify that this Judgment is a true and complete copy of the original which is on file in this case. Signature Of Attorney Date AOC-CR-142, Side Two, Rev. 6/97 (Structured Sentencing) 1997 Administrative Office of the Courts Date Delivered To Sheriff Signature Deputy CSC Assist. CSC CSC NOTE: If DWI, use AOC-CR-301 (active) or AOC-CR-310 (probation). If active sentence to DOC, use AOC-CR-602. If supervised probation, use AOC-CR-604. American LegalNet, Inc. www.FormsWorkFlow.com