File No. Law Enforcement Case No. WARRANT FOR ARREST COMMUNICATING THREATS THE STATE OF NORTH CAROLINA VS. Name And Address Of Defendant LID No. SID No. FBI No. STATE OF NORTH CAROLINA County In The General Court Of Justice District Court Division To any officer with authority and jurisdiction to execute a warrant for arrest for the offense charged below: 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 and willfully did threaten to physically injure the person and damage the property of . The threat was communicated to the person by Race Sex Social Security No. Date Of Birth Age Drivers License No. & State and the threat was made in a manner and under circumstances which would cause a reasonable person to believe that the threat was likely to be carried out and the person threatened believed that the threat would be carried out. Name Of Defendant's Employer Offense Code(s) Offense In Violation Of G.S. 5328 14-277.1 Date Of Offense Date Of Arrest & Check Digit No. (As Shown On Fingerprint Card) Complainant (Name, Address Or Department) Names & Addresses Of Witnesses (Including Counties & Telephone Nos.) This act was in violation of the law 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 above. Location Of Court Signature Misdemeanor Offense Which Requires Fingerprinting Per Fingerprint Plan Date Issued AOC-CR-105, Rev. 3/09 (Structured Sentencing) © 2009 Administrative Office of the Courts Magistrate Deputy CSC Assistant CSC Clerk Of Superior Court Court Date Court Time AM (Over) American LegalNet, Inc. www.FormsWorkFlow.com PM District Attorney 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 PLEA: guilty execute the Warrant and any information obtained about the whereabouts guilty of the defendant. guilty not guilty RETURN OF SERVICE I certify that this Warrant was received and served as follows: Date Received Date Served Time Served AM PM Date Returned By arresting the defendant and bringing the defendant before: Name Of Judicial Official This Warrant WAS NOT served for the following reason: Waived Attorney For Defendant Retained no contest no contest no contest VERDICT: PRIOR CONVICTIONS: Appointed Not Indigent No./Level: 0 guilty guilty guilty not guilty I (0) II (1-4) MISD. CLASS: MISD. CLASS: MISD. CLASS: Name Of Officer (Type Or Print) 1 1 1 2 2 2 3 3 3 JUDGMENT: The defendant appeared in open court and freely, voluntarily and understandingly entered the above plea; on the above verdict it is ORDERED that the defendant: pay costs and a fine of $ . be imprisoned for a term of days in the custody of the sheriff. DOC.* Pretrial credit days served. Work release is recommended. is not recommended. [ is ordered. (use form AOC-CR-602)] The Court finds that a longer shorter period of probation, than that which is specified in G.S. 15A-1343.2(d), is necessary. 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 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 any additional sums shown below. Fine Signature Of Officer Making Return III (5+) Restitution* Attorney's Fee Community Service Fee Other $ $ $ $ $ 0.00 *Name(s), address(es), amount(s) & social security number(s) of aggrieved party(ies) to receive restitution: Department Or Agency Of Officer REDELIVERY/REISSUANCE Date Signature Dep. CSC Assist. CSC CSC hours of community service during the first 6. complete service coordinator, and pay the fee prescribed by G.S. 143B-475.1(b) within 7. not be found in or on the premises of the complainant or 8. not assault, communicate with or be in the presence of the complainant or 9. Other: RETURN FOLLOWING REDELIVERY/REISSUANCE I certify that this Warrant was received and served as follows: Time Served Date Received Date Served Date Returned AM PM days of probation, as directed by the community days. . . By arresting the defendant and bringing the defendant before: Name Of Judicial Official This Warrant WAS NOT served for the following reason: Signature Of Officer Making Return It is ORDERED that this: case be consolidated for judgment with sentence is to run at the expiration of the sentence in 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: Judgment is continued upon payment of costs. . . 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. 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. Date Signature Of District Court Judge Date AOC-CR-105, Side Two, Rev. 3/09 (Structured Sentencing) © 2009 Administrative Office of the Courts Date Delivered To Sheriff Signature Deputy CSC Assist. CSC CSC NOTE: If DWI, use AOC-CR-342 (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