Fill and Sign the I the Undersigned Find that There is Probable Cause to Believe that on or About the Date of Offense Shown and Form

STA TE OF NORTH CA ROLINA File No. (Over) MISDEMEANOR CRIMINAL SUMMONS To the defendant: I, the undersigned, find that there is probable cause t o believe that on or about the date of offense shown a nd in the county named above you unlawfully and willfully di d This act was in violation of the law referred to in thi s Criminal Summons. This Summons is issued upon information furnished under oath by the complainant li sted. You are ORDERED to appear before the Court at the location, date and time indicated below to answer to the charge. If you fail to appear, an order for your arrest may be issued and you may be held in CONTEMPT OF C OURT and imprisoned for up to thirty (30) days or fined up to $500.00 or both. This penalty for failure to appear is in addition to any sentence which may be imposed for the crime charged. Signature AM PM THE STATE OF NORTH CAROLINA VS. Magistrate Assistant CSC Deputy CSC Clerk Of Superior Court AOC-CR-113, Rev. 12/03 (Structured Sentencing) Misdemeanor Offense Which Requires Fingerprinting Per Fingerprint Plan Offense Name And Address Of Defendant County Of Residence Telephone No. Race Sex Date Of Birth Age Social Security No. Drivers License No. & State Name Of Defendant's Employer Offense In Violation Of G.S. Date Of Offense Offense Code(s) Complainant (Name, Address Or Department) County of Residence Telephone No. Names & Addresses Of Witnesses (Including Counties & Telephone Nos.) Date Issued 2003 Administrative Office of the Courts Court Date Court Time Location Of Court In The General Court Of J ust ice Dist rict Court Div ision Count y Law Enforcement Case No. FBI No. LID No. SID No. PRIOR CONVICTIONS: Appointed Retained RETURN FOLLOWING REDELIV ERY/ REISSUA NCE REDELIVERY/ REISSUA NCE No./Level: If DWI, use AOC-CR-342 (active) or AOC-CR-310 (probation). If active sentence to DOC, u se AOC-CR-602. If supervised probation, use AOC-CR-604. I (0) The defendant, in open court, gives notice of appeal to the Superior Court. The current pretrial release order is modified as follows: 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: guilty guilty not guilty II (1-4) This Criminal Summons WAS NOT served for the following reason: pay costs and a fine of $ . CSC If this Criminal Summons is not served within ninety (90) 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 serve the Summons and any information obtained about the whereabouts of the defendant. RETURN OF SERVICE I certify that this Criminal Summons was received and served as follows: By personally serving this Criminal Summons on the defendant. no contest no contest PLEA: VERDICT: guilty guilty not guilty Signature Deputy CSC Assist. CSC 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 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 insti tution. (4) satisfy child support and family obligations, as required by the Court. (5) pay to the Clerk the costs of court and any additi onal sums shown below. $ $ $ $ $ *Name(s), address(es), amount(s) & social security number(s) of aggrieved p arty(ies) to receive restitution: . . I certify that this Judgment is a true and complete copy of the original which is on file in thi s case. CERTIFICATION Signature Of District Court Judge 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) 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 . 9. Other: This Criminal Summons WAS NOT served for the following reason: 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 com plied with the conditions of release pending appeal. It is ORDERED that this: Judgment is continued upon payment of costs. case be consolidated for judgment with sentence is to run at the expiration of the sentence in 0 III (5+) A PPEA L ENTRIES Signature Dep. CSC Assist. CSC CSC I certify that this Criminal Summons was received and served as follows: By personally serving this Criminal Summons on the defendant. M.CL. M.CL. A1 2 3 A1 2 3 Signature Of District Court Judge Signature Of Officer Making Return Signature Of Officer Making Return 11 AOC-CR-113, Side Two, Rev. 12/03 (Structured Sentencing) *NOTE: 2003 Administrative Office of the Courts Date Received Date Served Date Returned Department Or Agency Of Officer Date Date Received Date Served Date Returned Department Or Agency Of Officer Date Date Date Name Of District Court Judge (Type Or Print) Date Delivered To Sheriff Fine Restitution* Attorney's Fee Community Service Fee Other Waived Not Indigent District Attorney Attorney For Defendant