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ASSAULT ON GOVERNMENT OFFICER/EMPLOYEE [G.S. 14-33(C))4)] and strike ASSAULT BY POINTING A GUN [G.S. 14-34] pointing a gun, legal justification. SIMPLE ASSAULT [G.S. 14-33(a)] and strike by Date Of Arrest & Check Digit No. (As Shown On Fingerprint Card) WARRANT FOR ARREST MISDEMEANOR ASSAULT File No. Simple Serious Injury Deadly Weapon (Over) To any officer with authority and jurisdiction to execute a warrant for arrest for the offense charged below: 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 AM PM I. II. III. THE STATE OF NORTH CAROLINA VS. Magistrate Assistant CSC Deputy CSC Clerk Of Superior Court 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 On Female Pointing Gun On Gov't Off./Emp. IV. V. VI. Offense Code(s) . AOC-CR-102, Rev. 12/03 (Structured Sentencing) Misdemeanor Offense Which Requires Fingerprinting Per Fingerprint Plan 2003 Administrative Office of the Courts 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. Complainant (Name, Address Or Department) County Of Residence Telephone No. Names & Addresses Of Witnesses (Including Counties & Telephone Nos.) Date Issued Court Date Court Time Location Of Court Date Of Offense STATE OF NORTH CAROLINA In The General Court Of Justice District Court Division County (charge only one offense) I. Law Enforcement Case No. FBI No. LID No. SID No. ASSAULT ON A FEMALE BY A MALE OVER 18 [G.S. 14-33(c)(2)] and strike a female person, by The defendant is a male person and was at least 18 years of age when the offense occurred. IV. by At the time of the offense the (officer) (employee) was attempting to discharge the following duty of his/her (office) (employment) , a government (officer) (employee) . VI. V. by intentionally , at such person without . 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)] ASSAULT INFLICTING SERIOUS INJURY [G.S. 14-33(c)(1)] and strike by thereby inflicting serious injury (describe injury) , . , . II. 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)] ASSAULT WITH A DEADLY WEAPON [G.S. 14-33(c)(1)] with a deadly weapon, a by . , III. I. II. III. 1368 1387, 1350 1388, 1351 IV. V. VI. 1389 1322 1391 Waived Not Indigent . Name Of Judicial Official CERTIFICATION PRIOR CONVICTIONS: PLEA: Execution of the sentence is suspended and the defendant is placed on unsupervised probation* for 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. Work release 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 The Court finds that a District Attorney 1 No./Level: guilty guilty not guilty II (1-4) CSC no contest no contest VERDICT: guilty guilty not guilty Date Signature Deputy CSC Assist. CSC days in the custody of the sheriff. DOC.* Pretrial credit days served. is recommended. is not recommended. [ is ordered. (use form AOC-CR-602)] longer shorter period of probation, than that which is specified in G.S. 15A-1343.2(d), is necessary. $ Fine $ $ $ $ *Name(s), address(es), amount(s) & social security number(s) of aggrieved party(ies) to receive restitution: . . I certify that this Judgment is a true and complete copy of the original which is on file in this case. 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 . 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. 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 I (0) III (5+) M.CL. M.CL. A1 2 3 A1 2 3 1 AOC-CR-102, Side Two, Rev. 12/03 (Structured Sentencing) *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. 2003 Administrative Office of the Courts Date Date Delivered To Sheriff Name Of District Court Judge (Type Or Print) Restitution* Attorney's Fee Community Service Fee Other This Warrant WAS NOT served for the following reason: 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. I certify that this Warrant was received and served as follows: Date Returned RETURN OF SERVICE By arresting the defendant and bringing the defendant before: This Warrant WAS NOT served for the following reason: REDELIVERY/REISSUANCE Signature Dep. CSC Assist. CSC CSC Signature Of Officer Making Return APPEAL ENTRIES The defendant, in open court, gives notice of appeal to the Superior Court. The current pretrial release order is modified as follows: Signature Of District Court Judge Signature Of Officer Making Return RETURN FOLLOWING REDELIVERY/REISSUANCE I certify that this Warrant was received and served as follows: By arresting the defendant and bringing the defendant before: Date Received Date Served Department Or Agency Of Officer Date Date Received Date Served Date Returned Name Of Judicial Official Department Or Agency Of Officer Date Appointed Retained Attorney For Defendant months, 9. Other:

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