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Warrant For Arrest Employment Security Law Page 1 Form. This is a North Carolina form and can be use in Criminal Statewide.
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Tags: Warrant For Arrest Employment Security Law Page 1, CR-915M1, North Carolina Statewide, Criminal
Defendant(s)
:
......................................................
File No.
STATE OF NORTH CAROLINA
In The General Court Of Justice
District Court Division
THE PEOPLE OF THE STATE OF NEW YORK
WARRANT FOR ARREST
EMPLOYMENT SECURITY LAW TO
THE STATE OF NORTH CAROLINA VS.
Name And Address Of Defendant
County Of Residence
Date Of Birth
Sex
Social Security No.
ORIGINAL
2663
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 make a false statement
and representation knowing it to be false, and did knowingly fail to disclose a material fact, in that the
GREETINGS:
defendant reported to a representative of the Employment Security Commission of North Carolina the
"Reported Earnings" YOU, that all for the seven excuses being period which endedeach of "Ending Date"
WE COMMAND shown below business and day reporting laid aside, you and on the you attend before
shown below when the defendant in fact earned the "Actual Earnings" shown below from the employer
,
the Honorable
at the
Court
named below. The defendant's false statement and representation and failure to disclose a material fact
located at
Countywere to obtain and increase a benefit under the Employment Security Law.
of
Age
Drivers License No. & State
Name Of Defendant's Current Employer
Offense Code(s)
To any officer with authority and jurisdiction to execute a warrant for arrest for the offense charged below:
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
Ending Date
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Telephone No.
Race
County
Reported Earnings
Actual Earnings comply with this subpoena is punishable as a contempt of court and will make you liable to
Your failure to
$
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Name And Address Of Employer
From Whom Actual Earnings Earned
Offense In Violation Of G.S.
96.18(a)
Date Of Offense
$
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
Date Of Arrest & Check Digit No. (As Shown On Fingerprint Card)
Complainant (Name, Address Or Department)
(Attorney must sign above and type name below)
County Of Residence
Attorney(s) for
Telephone No.
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
Office and P.O. the charge above.
defendant before a judicial official without unnecessary delay to answer Address
Signature
Misdemeanor Offense Which
Requires Fingerprinting Per
Date Issued
AOC-CR-915M, Rev. 8/97 (Structured Sentencing)
1997 Administrative Office of the Courts
Location Of Court
Magistrate
Deputy CSC
Assistant CSC
Clerk Of Superior Court
ORIGINAL
Court Date
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
Court Time
AM
PM
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