North Carolina Indictment

STATE OF NORTH CAROLINA WARRANT FOR ARREST

File No.

STATE OF NORTH CAROLINA

In The General Court Of Justice District Court Division

County

To any officer with authority and jurisdiction to execute a warrant for arrest for the offenses charged below:

These act(s) were in violation of the laws 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 charges above.

I. FORGING ENDORSEMENT [G.S. 14-120]

On or about the date of offense shown and in the county named above the defendant named above unlawfully, willfully and feloniously did falsely make and forge an endorsement of

on a which is described as follows:

See attached copy of instrument.

II. UTTERING FORGED ENDORSEMENT [G.S. 14-120]

And, on or about the date of offense shown and in the county named above, the defendant named above unlawfully, willfully and feloniously did utter, publish, pass and deliver as true the instrument which is described in the charge above and which contained the falsely made and forged endorsement which is described in the charge above. The defendant knew at the time that the endorsement was falsely made and forged and acted for the sake of gain and with the intent to injure and defraud.

Offense Code(s) I. II.

Offense In Violation Of G.S.

Date Of Offense

Date Of Arrest & Check Digit No. (As Shown On Fingerprint Card)

Complainant (Name, Address Or Department)

County Of Residence Telephone No.

Names & Addresses Of Witnesses (Including Counties & Telephone Nos.)

WARRANT FOR ARREST

THE STATE OF NORTH CAROLINA VS.

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

JUDGMENT / COMMITMENT / RETURN OF SERVICE

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:

1 2 0

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.

pay costs and a fine of $

CSC

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.

RETURN OF SERVICE

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:

Signature Of Officer Making Return

Department Or Agency Of Officer

REDELIVERY

Date Signature

Dep. CSC Assist. CSC CSC

RETURN FOLLOWING REDELIVERY

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:

Signature Of Officer Making Return

Department Or Agency Of Officer

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

Date

WAIVER OF PROBABLE CAUSE HEARING

The undersigned defendant, with the consent of his/her attorney, waives the right to a probable cause hearing.

Signature Of Defendant

Signature Of Attorney

Date Waived

PRIOR CONVICTIONS:

No./Level:

Appointed Retained Waived

PLEA: guilty no contest not guilty

VERDICT: guilty no contest not guilty

MISD. CLASS: 1 2 3

Sentence / Probation Conditions

be imprisoned for a term of days in the custody of the sheriff. DOC. Pretrial days served. Work release is recommended. is not recommended. is ordered. (use form AOC-CR-602)

The Court finds that a longer period of probation, than that which is specified in G.S. 15A-1343.2(d), is

With defendant's consent, 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.

Fine $ Restitution* $ Attorney's Fee $ Community Service Fee $ Other $

*Name(s), address(es), amount(s) & social security number(s) of aggrieved party(ies) to receive restitution:

6. complete hours of community service during the first days of probation, as directed by the service coordinator, and pay the fee prescribed by G.S. 143B-475.1(b) days.

7. not be found in or on the premises of the complainant

8. not assault, communicate with or be in the presence of the complainant

9. Other

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

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 , and the defendant is bound over to Superior Court for action by the grand jury. No probable cause is found as to Count(s) of this Warrant, and the Count(s) is

CERTIFICATION

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

Date

Date Delivered To Sheriff Name Of District Court Judge (Type Or Print)

Attorney Attorney For Defendant At Time Of Trial Or Plea