Fill and Sign the State of North Carolina Warrant for Arrest Form

Dat e Of A rrest & Check Digit No. (A s Show n On Fingerprint Card) File No. (Ov er) W ARRANT FOR ARREST CONCEALM ENT OF M ERCHANDISE (SHOPLIFTING) STATE OF NORTH CAROLINA In The General Court Of J ust ice Dist rict Court Div ision Count y To any of f icer w it h aut horit y and jurisdict ion t o ex ecut e a w arrant f or arrest f or t he of f ense charged below : I, t he undersigned, f ind t hat t here is probable cause t o believ e t hat on or about t he dat e of of f ense show n and in t he count y named abov e t he def endant named abov e unlaw f ully and w illf ully did w it hout aut horit y conceal This act w as in v iolat ion of t he law ref erred t o in t his W arrant . This W arrant is issued upon inf ormat ion f urnished under oat h by t he complainant list ed. You are DIRECTED t o arrest t he def endant and bring t he def endant bef ore a judicial of f icial w it hout unnecessary delay t o answ er t he charge abov e. Signat ure A M PM THE STATE OF NORTH CAROLINA V S. M agist rat e A ssist ant CSC Deput y CSC Clerk Of Superior Court Of f ense In V iolat ion Of G. S. 2342 14-72. 1 premises of t he st ore and not hav ing t heret of ore purchased t he goods and merchandise. t he goods, and merchandise of a st ore , w hile st ill upon t he The def endant w as prev iously conv ict ed of t he crime of w illf ul concealment of a st ore' s goods on t he dat e and in t he court and count y list ed below . Date Of Conviction Dist rict Dist rict CourtSuperior Superior County A OC-CR-1 1 0 , Rev . 6 / 9 7 (St ruct ured Sent encing) 1 9 9 7 A dminist rat iv e Of f ice of t he Court s Name A nd A ddress Of Def endant Count y Of Residence Telephone No. Dat e Of Birt h A ge Driv ers License No. & St at e Race Sex Social Securit y No. Name Of Def endant ' s Employ er Of f ense Code(s) Dat e Of Of f ense Complainant (Name, A ddress Or Depart ment ) Count y Of Residence Telephone No. Names & A ddresses Of W it nesses (Including Count ies & Telephone Nos. ) Dat e Issued Court Time Court Dat e Locat ion Of Court APPEAL ENTRIES RETURN FOLLOW ING REDELIV ERY REDELIV ERY CERTIFICATION JUDGM ENT: The def endant appeared in open court and f reely , v olunt arily and underst andingly ent ered t he abov e plea; on t he abov e v erdict it is ORDERED t hat t he def endant : guilt y guilt y not guilt y 2 2 1 1 No./Level: This W arrant W A S NOT serv ed f or t he f ollow ing reason: pay cost s and a f ine of $ CSC If t his W arrant For A rrest is not serv ed w it hin one hundred and eight y (1 8 0 ) day s, it must be ret urned t o t he Clerk of Court in t he count y in w hich it w as issued w it h t he reason f or t he f ailure of serv ice not ed t hereon. The of f icer must st at e all st eps t aken by t he depart ment in at t empt ing t o ex ecut e t he W arrant and any inf ormat ion obt ained about t he w hereabout s of t he def endant . RETURN OF SERV ICE I cert if y t hat t his W arrant w as receiv ed and serv ed as f ollow s: By arrest ing t he def endant and bringing t he def endant bef ore: A ppoint ed Ret ained W aiv ed no cont est no cont est PLEA : V ERDICT guilt y guilt y not guilt y Signat ure Deput y CSC A ssist . CSC be imprisoned f or a t erm day s in t he cust ody of t he DOC. Pret rial day s W ork is is not [ is ordered. (use f orm A OC-CR-6 0 2 ) ] The Court f inds t hat longer short er period of probat ion, t han t hat w hich is specif ied in G. S. 1 5 A -1 3 4 3 . 2 (d), is W it h def endant ' s consent , ex ecut ion of t he sent ence is suspended and t he def endant is placed on unsuperv ised probat ion f or mont hs, subject t o t he f ollow ing condit ions: (1 ) commit no criminal of f ense in any jurisdict ion. (2 ) possess no f irear m, ex plosiv e or ot her deadly w eapon list ed in G. S. 1 4 -2 6 9 . (3 ) remain gainf ully and suit ably employ ed or f ait hf ully pursue a course of st udy or of v ocat ional t raining, t hat w ill equip t he def endant f or suit able employ ment , and abide by all rules of t he inst it ut ion. (4 ) sat isf y child support and f amily obligat ions, as required by t he Court . (5 ) pay t o t he Clerk t he cost s of court and any addit ional sums show n below . $ $ $ $ $ * Name(s), address(es), amount (s) & social securit y number(s) of aggriev ed part y (ies) t o receiv e rest it ut ion: I cert if y t hat t his J udgment is a t rue and complet e copy of t he original w hich is on f ile in t his case. Signat ure Of Dist rict Court J udge 6 . complet e hours of communit y serv ice during t he day s of probat ion, as direct ed by t he serv ice coordinat or, and pay t he f ee prescribed by G. S. 1 4 3 B-4 7 5 . 1 (b) day s. 7 . not be f ound in or on t he premises of t he complainant 8 . not assault , communicat e w it h or be in t he presence of t he complainant 9 . Ot her This W arrant W A S NOT serv ed f or t he f ollow ing reason: PRIOR CONV ICTIONS: M ISD. CLA SS: 3 3 COM M ITM ENT: It is ORDERED t hat t he Clerk deliv er t w o cert if ied copies of t his J udgment and Commit ment t o t he sherif f and t hat t he sherif f cause t he def endant t o be ret ained in cust ody t o serv e t he sent ence imposed or unt il t he def endant shall hav e complied w it h t he condit ions of release pending appeal. It is ORDERED t hat J udgment is cont inued upon pay ment of case be consolidat ed f or judgment w it h sent ence is t o run at t he ex pirat ion of t he sent ence 0 I (0) II (1-4) III (5+) The def endant , in open court , giv es not ice of appeal t o t he Superior Court . The current pret rial release order is modif ied as f ollow s: Signat ure Of Of f icer M aking Ret urn Signat ure Dep. CSC A ssist . CSC CSC I cert if y t hat t his W arrant w as receiv ed and serv ed as f ollow s: By arrest ing t he def endant and bringing t he def endant Signat ure Of Of f icer M aking Ret urn Signat ure Of Dist rict Court J udge A OC-CR-1 1 0 , Side Tw o, Rev . 6 / 9 7 (St ruct ured Sent encing) NOTE:If DW I, use A OC-CR-3 0 1 (act iv e) or A OC-CR-3 1 0 (probat ion). If act iv e sent ence t o DOC, use A OC-CR-6 0 2 . If superv ised probat ion, use A OC-CR-6 0 4 . 1 9 9 7 A dminist rat iv e Of f ice of t he Court s Dist rict A t t orney A t t orney For Def endant A t Time Of Trial Or Plea Fine Rest it ut ion* A t t orney ' s Fee Communit y Serv ice Fee Ot her Dat e Receiv ed Dat e Serv ed Dat e Ret urned Name Of J udicial Of f icial Depart ment Or A gency Of Of f icer Dat e Dat e Receiv ed Dat e Serv ed Dat e Ret urned Name Of J udicial Of f icial Depart ment Or A gency Of Of f icer Dat e Dat e Dat e Name Of Dist rict Court J udge (Ty pe Or Print ) Dat e Deliv ered To Sherif f .