Law Enforcement Case No. File No. WARRANT FOR ARREST MISDEMEANOR ASSAULT LID No. SID No. FBI No. STATE OF NORTH CAROLINA In The General Court Of Justice IV. On Female District Court Division County V. Pointing Gun VI. On Gov't Off./Emp. To any officer with authority and jurisdiction to execute a warrant for arrest for the offense charged below: THE STATE OF NORTH CAROLINA VS. I. Simple II. Serious Injury III. Deadly Weapon 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 assault (charge only one offense) Name And Address Of Defendant I. SIMPLE ASSAULT [G.S. 14-33(a)] and strike . by , . , . II. ASSAULT INFLICTING SERIOUS INJURY [G.S. 14-33(c)(1)] and strike by thereby inflicting serious injury (describe injury) Race Sex Social Security No. Date Of Birth Age Drivers License No. & State The defendant committed this offense against a person with whom the defendant has a personal relationship as defined in G.S. 50B-1 and in the presence of a minor. [G.S. 14-33(d)] with a deadly weapon, a . by The defendant committed this offense against a person with whom the defendant has a personal relationship and defined in G.S. 50B-1 (?) and in the presence of a minor. [G.S. 14-33(d)] Name Of Defendant's Employer Offense Code(s) I. 1368 II. 1387, 1350 III. 1388, 1351 Offense In Violation Of G.S. IV. 1389 V. 1322 VI. 1391 , III. ASSAULT WITH A DEADLY WEAPON [G.S. 14-33(c)(1)] IV. ASSAULT ON A FEMALE BY A MALE OVER 18 [G.S. 14-33(c)(2)] and strike a female person, by Date Of Offense The defendant is a male person and was at least 18 years of age when the offense occurred. Date Of Arrest & Check Digit No. (As Shown On Fingerprint Card) V. ASSAULT BY POINTING A GUN [G.S. 14-34] pointing a gun, legal justification. Complainant (Name, Address Or Department) by intentionally , at such person without VI. ASSAULT ON GOVERNMENT OFFICER/EMPLOYEE [G.S. 14-33(C))4)] and strike , a government (officer) (employee) . by At the time of the offense the (officer) (employee) was attempting to discharge the following duty of his/her (office) (employment) . 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. Signature Misdemeanor Offense Which Requires Fingerprinting Per Fingerprint Plan AOC-CR-102, Rev. 3/09 © 2009 Administrative Office of the Courts Date Issued Location Of Court 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 guilty PLEA: execute the Warrant and any information obtained about the whereabouts guilty of the defendant. RETURN OF SERVICE I certify that this Warrant was received and served as follows: Time Served Date Served Date Returned Date Received AM PM 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 Appointed Retained Not Indigent no contest no contest no contest PRIOR CONVICTIONS: No./Level: 0 I (0) II (1-4) Fine Name Of Officer (Type Or Print) Restitution* Attorney's Fee Community Service Fee Other $ Signature Of Officer Making Return III (5+) guilty 2 1 3 A1 M.CL. guilty 2 1 3 A1 M.CL. guilty guilty 2 1 3 A1 M.CL. not guilty not guilty 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.A. 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. VERDICT: $ $ $ $ *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 days of probation, as directed by the community 6. complete service coordinator, and pay the fee, and pay the fee prescribed by G.S. 143B-262.4(b) within days. 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 RETURN FOLLOWING REDELIVERY/REISSUANCE I certify that this Warrant was received and served as follows: Date Received Date Served Date Returned Time Served AM PM 9. Other: 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 Name Of Officer (Type Or Print) It is ORDERED that this: APPEAL ENTRIES The defendant, in open court, gives notice of appeal to the Superior Court. The current pretrial release order is modified as follows: . sentence is to run at the expiration of the sentence in Department Or Agency Of Officer Judgment is continued upon payment of costs. case be consolidated for judgment with . 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 Date Delivered To Sheriff Signature Deputy CSC Assist. CSC AOC-CR-102, Side Two, Rev. 3/09 (Structured Sentencing) © 2009 Administrative Office of the Courts 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