File No. STATE OF NORTH CAROLINA County WARRANT FOR ARREST I. FORGERY II. UTTERING 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(s) charged below: I, the undersigned, find that there is probable cause to believe that: THE STATE OF NORTH CAROLINA VS. Name And Address Of Defendant I. FORGERY [G.S. 14-119] On or about the date of offense shown and in the county named above the defendant named above unlawfully, willfully and feloniously did forge, falsely make and counterfeit a which is described as follows: (NOTE: Instead of describing the instrument with words and figures, you may attach the instrument or a photocopy of it to the warrant. If you do so, check the block below.) See attached copy of instrument. County Of Residence Telephone No. Race Date Of Birth Sex Social Security No. Age Drivers License No. & State Name Of Defendant's Employer The forgery, false making and counterfeiting consisted of the following: (Describe how the instrument was forged, falsely made and counterfeited.) Offense Code(s) I. 2520 II. 2524 Offense In Violation Of G.S. Date Of Offense The defendant acted without authority and with the intent to injure and defraud. Date Of Arrest & Check Digit No. (As Shown On Fingerprint Card) Complainant (Name, Address Or Department) County Of Residence Telephone No. Names & Addresses Of Witnesses (Including Counties & Telephone Nos.) II. UTTERING [G.S. 14-120] And, on or about the date of offense shown and in the county named above, the defendant named above unlawfully, willfully and feloniously did utter, publish, pass and deliver as true the forged, falsely made and counterfeit instrument which is described in the charge above. The defendant acted for the sake of gain and with the intent to injure and defraud and with knowledge that the instrument was forged, falsely made and counterfeited. 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 Deputy CSC Assistant CSC AOC-CR-109, Rev. 6/97 (Structured Sentencing) 1997 Administrative Office of the Courts Court Date Court Time AM PM NOTE Forgery of an Endorsement under G.S. 14-120 and Uttering a Forged Endorsement under G.S. 14-120 should not be charged with this Warrant. Use form AOC-CR-143. Magistrate Clerk Of Superior Court (Over) American LegalNet, Inc. www.FormsWorkflow.com 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 Retained No./Level: Waived PRIOR CONVICTIONS: 0 I (0) II (1-4) III (5+) VERDICT 1 2 3 guilty no contest guilty MISD. 1 2 3 guilty no contest guilty CLASS: 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 days in the custody of the sheriff. DOC. Pretrial Credit 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 longer shorter period of probation, than that which is specified in G.S. 15A-1343.2(d), is necessary. 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 course of study or of vocational training, that will equip the defendant for suitable employment, and abide by all rules of the reason: 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 PLEA: any additional sums shown below. Fine Restitution* Community Service Fee Other $ Department Or Agency Of Officer Attorney's Fee $ $ $ $ *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 Name Of Judicial Official 6. complete hours of community service during the first days of probation, as directed by the community service coordinator, and pay the fee prescribed by G.S. 143B-475.1(b) days. 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 9. Other This Warrant WAS NOT served for the following reason: Signature Of Officer Making Return Department Or Agency Of Officer It is ORDERED that 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 Judgment is continued upon payment of case be consolidated for judgment with sentence is to run at the expiration of the sentence 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 for action by the grand No probable cause is found as to Count(s) Date Name Of District Court Judge (Type Or Print) , and the defendant is bound over to Superior Court of this Warrant, and the Count(s) is 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-109, 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