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Fill and Sign the Clerk of the Superior Court of Form

Fill and Sign the Clerk of the Superior Court of Form

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State of North Carolina County of CERTIFICATE I, \ , Clerk of the Superior Court of County, North Carolina, a court of record, do hereby certify: 1. That \ is the District Attorney Assistant District Attorney of the Prosecutorial District of North Carolina; and that the attached application for the requisition of \ has been signed by the above named District Attorney or Assistant District Attorney as a\ foresaid; 2. That the indictment hereto attached is a true and correct copy of an ind\ ictment against , found to be a true bill on the day of , , by the grand jurors for the State of North Carolina in and for the County of , attending the Superior Court of the said county; that the original indic\ tment is on file in my office; and that the said indictment is now pending against the said \ . In testimony whereof, I have hereunto set my hand and affixed the seal o\ f the said Court, this day of , . Attach Certified/True Copies of Indictment. \ County, North Carolina \ Clerk of Superior Court Address (Seal of Court) GOV. 1-C, Rev. 2/16

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