Defendant(s) : ...................................................... Law Enforcement Case No. File No. WARRANT FOR ARREST OBTAINING PROPERTY LID No. THE PEOPLEOFTHE STATE CAROLINA STATE OF NORTH OF NEW YORK FBI No. In The General Court Of Justice District Court Division County TO BY FALSE PRETENSES SID No. 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, the undersigned, find that there is probable cause to believe that on or about the date of offense shown and GREETINGS: in the county named above the defendant named above unlawfully, willfully and feloniously did knowingly and designedly with the intent to cheat and defraud, obtain and attempt to obtain Name And Address Of Defendant County Of Residence Telephone No. Race Date Of Birth WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of from in room , on pretenseday of was calculated to deceive and did deceive. , 20 , at o'clock in the noon, and at any recessed by means of a falsethe which or adjourned date, to testify and give evidence as a witness in this action on the part of the The false pretense consisted of the following: Sex Social Security No. Age Drivers License No. & State Name Of Defendant's Employer Offense Code(s) Offense In Violation Of G.S. 14-100 2632 Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable 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. Court in Witness, Honorable County, , one of the Justices of the day of , 20 Date Of Offense Date Of Arrest & Check Digit No. (As Shown On Fingerprint Card) (Attorney must sign above and type name below) Complainant (Name, Address Or Department) Attorney(s) for County Of Residence Telephone No. (NOTE: For offenses committed on or after December 1, 1997, check this option if applicable.) The value of the items described above was $100,000.00 or more. 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 Office and P.O. Address 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 Date Issued Location Of Court Deputy CSC Assistant CSC AOC-CR-112, Rev. 12/03 (Structured Sentencing) 2003 Administrative Office of the Courts Magistrate Clerk Of Superior Court (Over) Telephone No.: Facsimile No.: Court Date E-Mail Address: Mobile Tel. No.: Court Time AM PM American LegalNet, Inc. www.USCourtForms.com : 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. not guilty 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 This Warrant WAS NOT served for the following reason: Retained No./Level: 0 guilty guilty not guilty I (0) II (1-4) MISD. CLASS: MISD. CLASS: III (5+) 1 1 2 2 3 3 JUDGMENT: The defendant appeared in open court and freely, voluntarily and understandingly entered the above plea; on the above . pay costs and a fine of $ verdict it is ORDERED that the defendant: TO 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 GREETINGS: 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. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Fine Restitution* Attorney's Fee Community Service Fee Other , the Honorable at the Court $ $ $ $ $ located at County of *Name(s), address(es), amount(s) & social security number(s) of aggrieved party(ies) to receive restitution: in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Signature Of Officer Making Return Department Or Agency Of Officer REDELIVERY/REISSUANCE Signature VERDICT: no contest no contest PRIOR CONVICTIONS: Appointed Not Indigent THE PEOPLE OF THE STATE OF NEW YORK RETURN OF SERVICE Date Defendant(s) Attorney For Defendant : . . . . . . . . . . . . . . Waived. . . . . . . . . . . . . . . . . . . . . . . . ... Dep. CSC Assist. CSC CSC RETURN FOLLOWING REDELIVERY/REISSUANCE 6. complete hours with this subpoena is punishable days of court and directed by you liable to Your failure to complyof community service during the first as a contemptof probation, as will makethe community service coordinator, and pay the fee prescribed by G.S. 143B-475.1(b) within days. the partynot be found in or on the premises of the complainant for a maximum penalty of $50 and all damages sustained as a . on whose behalf this subpoena was issued or 7. result 8. not assault, communicate with or be in the presence of the complainant or of your failure to comply. . By arresting the defendant and bringing the defendant before: 9. Other: Name Of Judicial Official I certify that this Warrant was received and served as follows: Date Received Date Served Date Returned This Warrant WAS NOT served for the following reason: Witness, Honorable Court in County, , one of the Justices of the day of , 20 Signature Of Officer Making Return (Attorney must sign above and type name below) Department Or Agency Of Officer 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: Date Signature Of District Court Judge WAIVER OF PROBABLE CAUSE HEARING Judgment is continued upon payment of costs. case be consolidated for judgment with sentence is to run at the expiration of the sentence in . . Attorney(s) for 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 jury. No probable cause is found as to Count(s) Office Date Name Of District Court Judge (Type Or Print) The undersigned defendant, with the consent of his/her attorney, waives the right to a probable cause hearing. Date Waived Signature Of Defendant , and the defendant is bound over to Superior of and P.O.this Warrant, and the Count(s) is dismissed. Address Signature Of District Court Judge CERTIFICATION Telephone No.: 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-112, Side Two, Rev. 12/03 (Structured Sentencing) 2003 Administrative Office of the Courts Facsimile No.: Deputy CSC E-Mail Address: Assist. CSC CSC Mobile Tel. No.: *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, Date Delivered To Sheriff Signature use AOC-CR-604. American LegalNet, Inc. www.USCourtForms.com