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Tab: Forms
FORMS TABLE OF CONTENTS
Arrest Warrant (AOC-CR-100) and Copy ........................................................................ Forms-Pg 1
Misdemeanor Criminal Summons (AOC-CR-113) and Copy .......................................... Forms-Pg 5
Magistrate’s Order (AOC-CR-116) and Copy ................................................................. Forms-Pg 9
Search Warrant (AOC-CR-119) and Copy ..................................................................... Forms-Pg 13
Conditions of Release and Release Order Form (AOC-CR-200) and Copy .................. Forms-Pg 17
Appearance Bond for Pretrial Release (AOC-CR-201) .................................................. Forms-Pg 21
Additional Accommodation Bondsmen (AOC-CR-201A)............................................. Forms-Pg 23
Surrender by Surety (AOC-CR-214) .............................................................................. Forms-Pg 25
Order for Arrest (AOC-CR-217) and Copy .................................................................... Forms-Pg 27
Order of Assignment or Denial of Counsel (AOC-CR-224) .......................................... Forms-Pg 31
Affidavit of Indigency (AOC-CR-226) .......................................................................... Forms-Pg 33
Transmittal of Out-of-County Process (AOC-CR-236) ................................................. Forms-Pg 35
Out-Of-County Process Verification Recall and
Transmission (AOC-CR-241) ........................................................................................ Forms-Pg 37
Detention of Impaired Driver (AOC-CR-270) ............................................................... Forms-Pg 39
Detention for Communicable Disease Testing (AOC-CR-270 side 2) ........................... Forms-Pg 40
Implied Consent Offense Notice (AOC-CR-271) .......................................................... Forms-Pg 41
Detention of Probationer Arrested for Felony (AOC-CR-272) ...................................... Forms-Pg 43
Detention of Defendant Arrested for Probation Violation
With Pending Felony or Prior Sex Offense (AOC-CR-272 side 2) ................................ Forms-Pg 44
Citation (AOC-CR-500) ................................................................................................. Forms-Pg 45
Conditions of Release for Person Charged With a Crime
of Domestic Violence (AOC-CR-630) ........................................................................... Forms-Pg 53
Conditions of Release for Persons Charged With Sex Offense
Or Crime of Violence Against Child Victim (AOC-CR-631) ........................................ Forms-Pg 55
All Forms Used by the AOC can be found at
http://www.nccourts.org/Forms/FormSearch.asp
Sex
STA
TE O
F N
OR
TH C
AR
OLI
NA
STA
TE O
F N
OR
TH C
AR
OLI
NA
STA
TE O
F N
OR
TH C
AR
OLI
NA
LID
No.
File
No.
Law
Enf
orce
men
t Cas
e N
o.
Nam
e O
f Def
enda
nt's
Em
ploy
er
Soc
ial S
ecur
ity N
o./T
ax ID
No.
Rac
eD
ate
Of B
irth
Driv
ers
Lice
nse
No.
& S
tate
THE
STA
TE O
F N
OR
TH C
AR
OLI
NA
VS.
Nam
e A
nd A
ddre
ss O
f Def
enda
nt
Age
Offe
nse
Cod
e(s)
Offe
nse
In V
iola
tion
Of G
.S.
Mis
dem
eano
r Offe
nse
Whi
ch R
equi
res
Fing
erpr
intin
g Pe
r Fin
gerp
rint P
lan
Dat
e Is
sued
Dat
e O
f Offe
nse
Dat
e O
f Arr
est &
Che
ck D
igit
No.
(As
Sho
wn
On
Fing
erpr
int C
ard)
Com
plai
nant
(Nam
e, A
ddre
ss O
r Dep
artm
ent)
Nam
es &
Add
ress
es O
f Witn
esse
s (In
clud
ing
Cou
ntie
s &
Tel
epho
ne N
os.)
WA
RR
AN
T FO
R A
RR
EST
Offe
nse
In T
he G
ener
al C
ourt
Of J
ustic
e D
istri
ct C
ourt
Div
isio
nC
ount
y
FBI N
o.S
ID N
o.
AO
C-C
R-1
00, R
ev. 4
/11
(Stru
ctur
ed S
ente
ncin
g) ©
201
1 A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
Sig
natu
re
Cou
rt Ti
me
PM
AM
Loca
tion
Of C
ourt
Cou
rt D
ate
Dep
uty
CS
CC
lerk
Of S
uper
ior C
ourt
Mag
istra
te
Ass
ista
nt C
SC
This
act
(s) w
as in
vio
latio
n of
the
law
(s) r
efer
red
to in
this
War
rant
. Thi
s W
arra
nt is
issu
ed u
pon
info
rmat
ion
furn
ishe
d un
der o
ath
by th
e co
mpl
aina
nt li
sted
. You
are
DIR
ECTE
D to
arr
est t
he d
efen
dant
and
brin
g th
e de
fend
ant b
efor
e a
judi
cial
offi
cial
with
out u
nnec
essa
ry d
elay
to a
nsw
er th
e ch
arge
(s) a
bove
.
To a
ny o
ffice
r with
aut
horit
y an
d ju
risdi
ctio
n to
exe
cute
a w
arra
nt fo
r arr
est f
or th
e of
fens
e(s)
cha
rged
bel
ow:
Cou
nty
WA
RR
AN
T FO
R A
RR
EST
Offe
nse
RET
UR
N F
OLL
OW
ING
RED
ELIV
ERY/
REI
SSU
ANC
E
RED
ELIV
ERY/
REI
SSU
AN
CE
Dat
e S
erve
d
Dat
e S
erve
d
*Nam
e(s)
, add
ress
(es)
, and
am
ount
(s) f
or a
ggrie
ved
party
(ies)
to re
ceiv
e re
stitu
tion:
(Not
e To
Cle
rk: R
ecor
d S
SN
or T
ax ID
No.
of a
ggrie
ved
party
(ies)
on
AO
C-C
R-3
82, "
Cer
tific
atio
n O
f Ide
ntity
(Vic
tims'
Res
titut
ion)
/Cer
tific
atio
n O
f Ide
ntity
(Witn
ess
Atte
ndan
ce)."
)
sent
ence
is to
run
at th
e ex
pira
tion
of th
e se
nten
ce in
.
JUD
GM
ENT:
The
def
enda
nt a
ppea
red
in o
pen
cour
t and
free
ly, v
olun
taril
y an
d un
ders
tand
ingl
y en
tere
d th
e ab
ove
plea
; on
the
abov
e ve
rdic
t, it
is O
RD
ERED
that
the
defe
ndan
t:
p
ay c
osts
and
a fi
ne o
f $
.
be im
pris
oned
for a
term
of
day
s in
the
cust
ody
of
th
e sh
eriff
.
D
OC
.* P
retri
al c
redi
t
day
s se
rved
.W
ork
rele
ase
is
reco
mm
ende
d.
is n
ot re
com
men
ded.
[
is
ord
ered
. (us
e fo
rm A
OC
-CR
-602
)]Th
e C
ourt
finds
that
a
long
er
sho
rter
per
iod
of p
roba
tion,
than
that
whi
ch is
spe
cifie
d in
G.A
. 15A
-134
3.2(
d) is
nec
essa
ry.
Exe
cutio
n of
the
sent
ence
is s
uspe
nded
and
the
defe
ndan
t is
plac
ed o
n un
supe
rvis
ed p
roba
tion*
for
mon
ths,
sub
ject
to
the
follo
win
g co
nditi
ons:
(1)
com
mit
no c
rimin
al o
ffens
e in
any
juris
dict
ion.
(2) p
osse
ss n
o fir
earm
, exp
losi
ve o
r oth
er d
eadl
y w
eapo
n lis
ted
in G
.S. 1
4-26
9. (3
) rem
ain
gain
fully
and
sui
tabl
y em
ploy
ed o
r fai
thfu
lly p
ursu
e a
cour
se o
f stu
dy o
r of v
ocat
iona
l tra
inin
g, th
at w
ill
equi
p th
e de
fend
ant f
or s
uita
ble
empl
oym
ent,
and
abid
e by
all
rule
s of
the
inst
itutio
n. (4
) sat
isfy
chi
ld s
uppo
rt an
d fa
mily
obl
igat
ions
, as
requ
ired
by th
e C
ourt.
(5)
pay
to th
e C
lerk
the
cost
s of
cou
rt an
d an
y ad
ditio
nal s
ums
show
n be
low
.
$Fine
Nam
e O
f Offi
cer (
Type
Or P
rint)
T
his
War
rant
WA
S N
OT
serv
ed fo
r the
follo
win
g re
ason
:
Dep
uty
CS
CA
ssis
t. C
SC
CS
C
com
plet
e
h
ours
of c
omm
unity
ser
vice
dur
ing
the
first
day
s of
pro
batio
n, a
s di
rect
ed b
y th
e co
mm
unity
se
rvic
e co
ordi
nato
r, an
d pa
y th
e fe
e pr
escr
ibed
by
G.S
. 143
B-2
62.4
(b) w
ithin
d
ays.
guilt
ygu
ilty
guilt
yno
t gui
lty
$$
$$
Res
titut
ion*
Atto
rney
's F
eeC
omm
unity
Ser
vice
Fee
Oth
er
6.
prov
ide
a D
NA
sam
ple
purs
uant
to G
.S. 1
5A-2
66.4
. (A
OC
-CR
-319
)
7. 8. 9.
not b
e fo
und
in o
r on
the
prem
ises
of t
he c
ompl
aina
nt o
r
.no
t ass
ault,
com
mun
icat
e w
ith o
r be
in th
e pr
esen
ce o
f the
com
plai
nant
or
.
10.
App
oint
ed
Ret
aine
dW
aive
d
Not
Indi
gent
AM PM
Tim
e S
erve
d
CER
TIFI
CA
TIO
NS
igna
ture
Of D
efen
dant
Dat
e W
aive
d
APP
EAL
ENTR
IES
guilt
ygu
ilty
guilt
yno
t gui
lty
no c
onte
stno
con
test
no c
onte
st
Dat
eI c
ertif
y th
at th
is J
udgm
ent i
s a
true
and
com
plet
e co
py o
f the
orig
inal
whi
ch is
on
file
in th
is c
ase.
The
defe
ndan
t, in
ope
n co
urt,
give
s no
tice
of a
ppea
l to
the
Sup
erio
r Cou
rt.Th
e cu
rrent
pre
trial
rele
ase
orde
r is
mod
ified
as
follo
ws:
RET
UR
N O
F SE
RVI
CE
PRIO
R C
ON
VIC
TIO
NS:
© 2
011
Adm
inis
trativ
e O
ffice
of t
he C
ourts
WA
IVER
OF
PRO
BA
BLE
CA
USE
HEA
RIN
G
No.
/Lev
el:
AOC
-CR
-100
, Sid
e Tw
o, R
ev. 4
/11
(Stru
ctur
ed S
ente
ncin
g)
0
CO
MM
ITM
ENT:
It i
s O
RD
ERED
that
the
Cle
rk d
eliv
er tw
o ce
rtifie
d co
pies
of t
his
Judg
men
t and
Com
mitm
ent t
o th
e sh
eriff
and
that
the
sher
iff c
ause
the
defe
ndan
t to
be re
tain
ed in
cus
tody
to s
erve
the
sent
ence
impo
sed
or u
ntil
the
defe
ndan
t sha
ll ha
ve c
ompl
ied
with
the
cond
ition
s of
rele
ase
pend
ing
appe
al.
If th
is W
arra
nt F
or A
rres
t is
not s
erve
d w
ithin
one
hun
dred
and
eig
hty
(180
) day
s, it
mus
t be
retu
rned
to th
e C
lerk
of C
ourt
in th
e co
unty
in w
hich
it w
as is
sued
with
the
reas
on fo
r the
failu
re o
f ser
vice
not
ed th
ereo
n. T
he
offic
er m
ust s
tate
all
step
s ta
ken
by th
e de
partm
ent i
n at
tem
ptin
g to
ex
ecut
e th
e W
arra
nt a
nd a
ny in
form
atio
n ob
tain
ed a
bout
the
whe
reab
outs
of th
e de
fend
ant.
I cer
tify
that
this
War
rant
was
rece
ived
and
ser
ved
as fo
llow
s:D
ate
Rec
eive
dD
ate
Ret
urne
d
Sig
natu
re
Dep
. CS
C
Ass
ist.
CS
CC
SC
I cer
tify
that
this
War
rant
was
rece
ived
and
ser
ved
as fo
llow
s:D
ate
Rec
eive
dD
ate
Ret
urne
d
B
y ar
rest
ing
the
defe
ndan
t and
brin
ging
the
defe
ndan
t bef
ore:
Nam
e O
f Jud
icia
l Offi
cial
T
his
War
rant
WA
S N
OT
serv
ed fo
r the
follo
win
g re
ason
:
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
Dep
artm
ent O
r Age
ncy
Of O
ffice
r
Sig
natu
re O
f Dis
trict
Cou
rt Ju
dge
The
unde
rsig
ned
defe
ndan
t, w
ith th
e co
nsen
t of h
is/h
er a
ttorn
ey, w
aive
s th
e rig
ht to
a p
roba
ble
caus
e he
arin
g.
Sig
natu
re O
f Atto
rney
B
y ar
rest
ing
the
defe
ndan
t and
brin
ging
the
defe
ndan
t bef
ore:
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
I (0)
II (1
-4)
III (
5+)
Sig
natu
re
*NO
TE:
PRO
BA
BLE
CA
USE
:
Pro
babl
e ca
use
is fo
und
as to
all
Cou
nts
exce
pt
,
and
the
defe
ndan
t is
boun
d ov
er to
Sup
erio
r C
ourt
for a
ctio
n by
the
gran
d ju
ry.
No
prob
able
cau
se is
foun
d as
to C
ount
(s)
o
f thi
s W
arra
nt, a
nd th
e C
ount
(s) i
s di
smis
sed.
D
ate
Sig
natu
re O
f Dis
trict
Cou
rt Ju
dge
If D
WI,
use
AO
C-C
R-3
42 (a
ctiv
e) o
r AO
C-C
R-3
10 (p
roba
tion)
. If a
ctiv
e se
nten
ce to
DO
C, u
se A
OC
-CR
-602
. If s
uper
vise
d pr
obat
ion,
us
e A
OC
-CR
-604
.
Nam
e O
f Jud
icia
l Offi
cial
Dep
artm
ent O
r Age
ncy
Of O
ffice
r
Dat
e
Dat
e
Dat
e D
eliv
ered
To
She
riff
Nam
e O
f Dis
trict
Cou
rt Ju
dge
(Typ
e O
r Prin
t)
2 2 2
1 1 1
3 3 3
A1 A1 A1
PLEA
:
Dis
trict
Atto
rney
VER
DIC
T:M
.CL.
M.C
L.M
.CL.
It is
ORD
ERED
tha
t th
is:
Judg
men
t is
cont
inue
d up
on p
aym
ent o
f cos
ts.
case
be
cons
olid
ated
for j
udgm
ent w
ith
.
Oth
er:
Atto
rney
For
Def
enda
nt
AM PM
Tim
e S
erve
d
Nam
e O
f Offi
cer (
Type
Or P
rint)
Sex
STA
TE O
F N
OR
TH C
AR
OLI
NA
STA
TE O
F N
OR
TH C
AR
OLI
NA
STA
TE O
F N
OR
TH C
AR
OLI
NA
LID
No.
File
No.
Law
Enf
orce
men
t Cas
e N
o.
Nam
e O
f Def
enda
nt's
Em
ploy
er
Soc
ial S
ecur
ity N
o./T
ax ID
No.
Rac
eD
ate
Of B
irth
Driv
ers
Lice
nse
No.
& S
tate
THE
STA
TE O
F N
OR
TH C
AR
OLI
NA
VS.
Nam
e A
nd A
ddre
ss O
f Def
enda
nt
Age
Offe
nse
Cod
e(s)
Offe
nse
In V
iola
tion
Of G
.S.
Mis
dem
eano
r Offe
nse
Whi
ch R
equi
res
Fing
erpr
intin
g Pe
r Fin
gerp
rint P
lan
Dat
e Is
sued
Dat
e O
f Offe
nse
Dat
e O
f Arr
est &
Che
ck D
igit
No.
(As
Sho
wn
On
Fing
erpr
int C
ard)
Com
plai
nant
(Nam
e, A
ddre
ss O
r Dep
artm
ent)
Nam
es &
Add
ress
es O
f Witn
esse
s (In
clud
ing
Cou
ntie
s &
Tel
epho
ne N
os.)
WA
RR
AN
T FO
R A
RR
EST
Offe
nse
In T
he G
ener
al C
ourt
Of J
ustic
e D
istri
ct C
ourt
Div
isio
nC
ount
y
FBI N
o.S
ID N
o.
AO
C-C
R-1
00, R
ev. 4
/11
(Stru
ctur
ed S
ente
ncin
g) ©
201
1 A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
Sig
natu
re
Cou
rt Ti
me
PM
AM
Loca
tion
Of C
ourt
Cou
rt D
ate
Dep
uty
CS
CC
lerk
Of S
uper
ior C
ourt
Mag
istra
te
Ass
ista
nt C
SC
This
act
(s) w
as in
vio
latio
n of
the
law
(s) r
efer
red
to in
this
War
rant
. Thi
s W
arra
nt is
issu
ed u
pon
info
rmat
ion
furn
ishe
d un
der o
ath
by th
e co
mpl
aina
nt li
sted
. You
are
DIR
ECTE
D to
arr
est t
he d
efen
dant
and
brin
g th
e de
fend
ant b
efor
e a
judi
cial
offi
cial
with
out u
nnec
essa
ry d
elay
to a
nsw
er th
e ch
arge
(s) a
bove
.
To a
ny o
ffice
r with
aut
horit
y an
d ju
risdi
ctio
n to
exe
cute
a w
arra
nt fo
r arr
est f
or th
e of
fens
e(s)
cha
rged
bel
ow:
Cou
nty
WA
RR
AN
T FO
R A
RR
EST
Offe
nse
RET
UR
N F
OLL
OW
ING
RED
ELIV
ERY/
REI
SSU
ANC
E
RED
ELIV
ERY/
REI
SSU
AN
CE
Dat
e S
erve
d
Dat
e S
erve
d
*Nam
e(s)
, add
ress
(es)
, and
am
ount
(s) f
or a
ggrie
ved
party
(ies)
to re
ceiv
e re
stitu
tion:
(Not
e To
Cle
rk: R
ecor
d S
SN
or T
ax ID
No.
of a
ggrie
ved
party
(ies)
on
AO
C-C
R-3
82, "
Cer
tific
atio
n O
f Ide
ntity
(Vic
tims'
Res
titut
ion)
/Cer
tific
atio
n O
f Ide
ntity
(Witn
ess
Atte
ndan
ce)."
)
sent
ence
is to
run
at th
e ex
pira
tion
of th
e se
nten
ce in
.
JUD
GM
ENT:
The
def
enda
nt a
ppea
red
in o
pen
cour
t and
free
ly, v
olun
taril
y an
d un
ders
tand
ingl
y en
tere
d th
e ab
ove
plea
; on
the
abov
e ve
rdic
t, it
is O
RD
ERED
that
the
defe
ndan
t:
p
ay c
osts
and
a fi
ne o
f $
.
be im
pris
oned
for a
term
of
day
s in
the
cust
ody
of
th
e sh
eriff
.
D
OC
.* P
retri
al c
redi
t
day
s se
rved
.W
ork
rele
ase
is
reco
mm
ende
d.
is n
ot re
com
men
ded.
[
is
ord
ered
. (us
e fo
rm A
OC
-CR
-602
)]Th
e C
ourt
finds
that
a
long
er
sho
rter
per
iod
of p
roba
tion,
than
that
whi
ch is
spe
cifie
d in
G.A
. 15A
-134
3.2(
d) is
nec
essa
ry.
Exe
cutio
n of
the
sent
ence
is s
uspe
nded
and
the
defe
ndan
t is
plac
ed o
n un
supe
rvis
ed p
roba
tion*
for
mon
ths,
sub
ject
to
the
follo
win
g co
nditi
ons:
(1)
com
mit
no c
rimin
al o
ffens
e in
any
juris
dict
ion.
(2) p
osse
ss n
o fir
earm
, exp
losi
ve o
r oth
er d
eadl
y w
eapo
n lis
ted
in G
.S. 1
4-26
9. (3
) rem
ain
gain
fully
and
sui
tabl
y em
ploy
ed o
r fai
thfu
lly p
ursu
e a
cour
se o
f stu
dy o
r of v
ocat
iona
l tra
inin
g, th
at w
ill
equi
p th
e de
fend
ant f
or s
uita
ble
empl
oym
ent,
and
abid
e by
all
rule
s of
the
inst
itutio
n. (4
) sat
isfy
chi
ld s
uppo
rt an
d fa
mily
obl
igat
ions
, as
requ
ired
by th
e C
ourt.
(5)
pay
to th
e C
lerk
the
cost
s of
cou
rt an
d an
y ad
ditio
nal s
ums
show
n be
low
.
$Fine
Nam
e O
f Offi
cer (
Type
Or P
rint)
T
his
War
rant
WA
S N
OT
serv
ed fo
r the
follo
win
g re
ason
:
Dep
uty
CS
CA
ssis
t. C
SC
CS
C
com
plet
e
h
ours
of c
omm
unity
ser
vice
dur
ing
the
first
day
s of
pro
batio
n, a
s di
rect
ed b
y th
e co
mm
unity
se
rvic
e co
ordi
nato
r, an
d pa
y th
e fe
e pr
escr
ibed
by
G.S
. 143
B-2
62.4
(b) w
ithin
d
ays.
guilt
ygu
ilty
guilt
yno
t gui
lty
$$
$$
Res
titut
ion*
Atto
rney
's F
eeC
omm
unity
Ser
vice
Fee
Oth
er
6.
prov
ide
a D
NA
sam
ple
purs
uant
to G
.S. 1
5A-2
66.4
. (A
OC
-CR
-319
)
7. 8. 9.
not b
e fo
und
in o
r on
the
prem
ises
of t
he c
ompl
aina
nt o
r
.no
t ass
ault,
com
mun
icat
e w
ith o
r be
in th
e pr
esen
ce o
f the
com
plai
nant
or
.
10.
App
oint
ed
Ret
aine
dW
aive
d
Not
Indi
gent
AM PM
Tim
e S
erve
d
CER
TIFI
CA
TIO
NS
igna
ture
Of D
efen
dant
Dat
e W
aive
d
APP
EAL
ENTR
IES
guilt
ygu
ilty
guilt
yno
t gui
lty
no c
onte
stno
con
test
no c
onte
st
Dat
eI c
ertif
y th
at th
is J
udgm
ent i
s a
true
and
com
plet
e co
py o
f the
orig
inal
whi
ch is
on
file
in th
is c
ase.
The
defe
ndan
t, in
ope
n co
urt,
give
s no
tice
of a
ppea
l to
the
Sup
erio
r Cou
rt.Th
e cu
rrent
pre
trial
rele
ase
orde
r is
mod
ified
as
follo
ws:
RET
UR
N O
F SE
RVI
CE
PRIO
R C
ON
VIC
TIO
NS:
© 2
011
Adm
inis
trativ
e O
ffice
of t
he C
ourts
WA
IVER
OF
PRO
BA
BLE
CA
USE
HEA
RIN
G
No.
/Lev
el:
AOC
-CR
-100
, Sid
e Tw
o, R
ev. 4
/11
(Stru
ctur
ed S
ente
ncin
g)
0
CO
MM
ITM
ENT:
It i
s O
RD
ERED
that
the
Cle
rk d
eliv
er tw
o ce
rtifie
d co
pies
of t
his
Judg
men
t and
Com
mitm
ent t
o th
e sh
eriff
and
that
the
sher
iff c
ause
the
defe
ndan
t to
be re
tain
ed in
cus
tody
to s
erve
the
sent
ence
impo
sed
or u
ntil
the
defe
ndan
t sha
ll ha
ve c
ompl
ied
with
the
cond
ition
s of
rele
ase
pend
ing
appe
al.
If th
is W
arra
nt F
or A
rres
t is
not s
erve
d w
ithin
one
hun
dred
and
eig
hty
(180
) day
s, it
mus
t be
retu
rned
to th
e C
lerk
of C
ourt
in th
e co
unty
in w
hich
it w
as is
sued
with
the
reas
on fo
r the
failu
re o
f ser
vice
not
ed th
ereo
n. T
he
offic
er m
ust s
tate
all
step
s ta
ken
by th
e de
partm
ent i
n at
tem
ptin
g to
ex
ecut
e th
e W
arra
nt a
nd a
ny in
form
atio
n ob
tain
ed a
bout
the
whe
reab
outs
of th
e de
fend
ant.
I cer
tify
that
this
War
rant
was
rece
ived
and
ser
ved
as fo
llow
s:D
ate
Rec
eive
dD
ate
Ret
urne
d
Sig
natu
re
Dep
. CS
C
Ass
ist.
CS
CC
SC
I cer
tify
that
this
War
rant
was
rece
ived
and
ser
ved
as fo
llow
s:D
ate
Rec
eive
dD
ate
Ret
urne
d
B
y ar
rest
ing
the
defe
ndan
t and
brin
ging
the
defe
ndan
t bef
ore:
Nam
e O
f Jud
icia
l Offi
cial
T
his
War
rant
WA
S N
OT
serv
ed fo
r the
follo
win
g re
ason
:
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
Dep
artm
ent O
r Age
ncy
Of O
ffice
r
Sig
natu
re O
f Dis
trict
Cou
rt Ju
dge
The
unde
rsig
ned
defe
ndan
t, w
ith th
e co
nsen
t of h
is/h
er a
ttorn
ey, w
aive
s th
e rig
ht to
a p
roba
ble
caus
e he
arin
g.
Sig
natu
re O
f Atto
rney
B
y ar
rest
ing
the
defe
ndan
t and
brin
ging
the
defe
ndan
t bef
ore:
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
I (0)
II (1
-4)
III (
5+)
Sig
natu
re
*NO
TE:
PRO
BA
BLE
CA
USE
:
Pro
babl
e ca
use
is fo
und
as to
all
Cou
nts
exce
pt
,
and
the
defe
ndan
t is
boun
d ov
er to
Sup
erio
r C
ourt
for a
ctio
n by
the
gran
d ju
ry.
No
prob
able
cau
se is
foun
d as
to C
ount
(s)
o
f thi
s W
arra
nt, a
nd th
e C
ount
(s) i
s di
smis
sed.
D
ate
Sig
natu
re O
f Dis
trict
Cou
rt Ju
dge
If D
WI,
use
AO
C-C
R-3
42 (a
ctiv
e) o
r AO
C-C
R-3
10 (p
roba
tion)
. If a
ctiv
e se
nten
ce to
DO
C, u
se A
OC
-CR
-602
. If s
uper
vise
d pr
obat
ion,
us
e A
OC
-CR
-604
.
Nam
e O
f Jud
icia
l Offi
cial
Dep
artm
ent O
r Age
ncy
Of O
ffice
r
Dat
e
Dat
e
Dat
e D
eliv
ered
To
She
riff
Nam
e O
f Dis
trict
Cou
rt Ju
dge
(Typ
e O
r Prin
t)
2 2 2
1 1 1
3 3 3
A1 A1 A1
PLEA
:
Dis
trict
Atto
rney
VER
DIC
T:M
.CL.
M.C
L.M
.CL.
It is
ORD
ERED
tha
t th
is:
Judg
men
t is
cont
inue
d up
on p
aym
ent o
f cos
ts.
case
be
cons
olid
ated
for j
udgm
ent w
ith
.
Oth
er:
Atto
rney
For
Def
enda
nt
AM PM
Tim
e S
erve
d
Nam
e O
f Offi
cer (
Type
Or P
rint)
File
No.
STA
TE O
F N
OR
TH C
AR
OLI
NA
Law
Enf
orce
men
t Cas
e N
o.LI
D N
o.
Cou
rt Ti
me
Cou
rt D
ate
Dat
e O
f Arr
est &
Che
ck D
igit
No.
(As
Sho
wn
On
Fing
erpr
int C
ard)
Com
plai
nant
(Nam
e, A
ddre
ss O
r Dep
artm
ent)
Mis
dem
eano
r Offe
nse
Whi
ch R
equi
res
Fing
erpr
intin
g Pe
r Fin
gerp
rint P
lan
Dat
e Is
sued
Driv
ers
Lice
nse
No.
& S
tate
Soc
ial S
ecur
ity N
o.
Nam
e O
f Def
enda
nt's
Em
ploy
er
Dat
e O
f Offe
nse
Offe
nse
Cod
e(s)
Offe
nse
In V
iola
tion
Of G
.S.
THE
STA
TE O
F N
OR
TH C
AR
OLI
NA
VS.
Nam
e A
nd A
ddre
ss O
f Def
enda
nt
Rac
eS
exD
ate
Of B
irth
Age
Offe
nse
To th
e de
fend
ant:
I, th
e un
ders
igne
d, fi
nd th
at th
ere
is p
roba
ble
caus
e to
bel
ieve
that
on
or a
bout
the
date
of o
ffens
e sh
own
and
in th
e co
unty
nam
ed a
bove
you
unl
awfu
lly a
nd w
illful
ly d
id
MIS
DEM
EAN
OR
CR
IMIN
AL
SUM
MO
NS
This
act
was
in v
iola
tion
of th
e la
w re
ferr
ed to
in th
is C
rimin
al S
umm
ons.
Thi
s Su
mm
ons
is is
sued
upo
n in
form
atio
n fu
rnis
hed
unde
r oat
h by
the
com
plai
nant
list
ed.
You
are
OR
DER
ED to
app
ear b
efor
e th
e C
ourt
at
the
loca
tion,
dat
e an
d tim
e in
dica
ted
belo
w to
ans
wer
to th
e ch
arge
. If
you
fail
to a
ppea
r, an
ord
er fo
r you
r ar
rest
may
be
issu
ed a
nd y
ou m
ay b
e he
ld in
CO
NTE
MPT
OF
CO
UR
T an
d im
pris
oned
for u
p to
thirt
y (3
0)
days
or f
ined
up
to $
500.
00 o
r bot
h. T
his
pena
lty fo
r fai
lure
to a
ppea
r is
in a
dditi
on to
any
sen
tenc
e w
hich
m
ay b
e im
pose
d fo
r the
crim
e ch
arge
d.
AO
C-C
R-1
13, R
ev. 3
/09
(Stru
ctur
ed S
ente
ncin
g)©
200
9 A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
Nam
es &
Add
ress
es O
f Witn
esse
s (In
clud
ing
Cou
ntie
s &
Tel
epho
ne N
os.)
In T
he G
ener
al C
ourt
Of J
ustic
e D
istri
ct C
ourt
Div
isio
nC
ount
y
Sig
natu
re
PM
AM
Dep
uty
CS
CC
lerk
Of S
uper
ior C
ourt
Mag
istra
te
Ass
ista
nt C
SC
Loca
tion
Of C
ourt
Loca
tion
Of C
ourt
SID
No.
FBI N
o.
Nam
e O
f Offi
cer (
Type
Or P
rint)
Dep
uty
CS
C
Ass
ist.
CS
C
C
SC
guilt
ygu
ilty
guilt
yno
t gui
lty
*Nam
e(s)
, add
ress
(es)
, am
ount
(s) &
soc
ial s
ecur
ity n
umbe
r(s)
of a
ggrie
ved
party
(ies)
to re
ceiv
e re
stitu
tion:
Exe
cutio
n of
the
sent
ence
is s
uspe
nded
and
the
defe
ndan
t is
plac
ed o
n un
supe
rvis
ed p
roba
tion*
for
mon
ths,
sub
ject
to th
e fo
llow
ing
cond
ition
s: (
1) c
omm
it no
crim
inal
offe
nse
in a
ny ju
risdi
ctio
n. (2
) pos
sess
no
firea
rm, e
xplo
sive
or o
ther
de
adly
wea
pon
liste
d in
G.S
. 14-
269.
(3)
rem
ain
gain
fully
and
sui
tabl
y em
ploy
ed o
r fai
thfu
lly p
ursu
e a
cour
se o
f stu
dy o
r of v
ocat
iona
l tra
inin
g, th
at w
ill e
quip
the
defe
ndan
t for
sui
tabl
e em
ploy
men
t, an
d ab
ide
by a
ll ru
les
of th
e in
stitu
tion.
(4)
sat
isfy
chi
ld s
uppo
rt an
d fa
mily
obl
igat
ions
, as
requ
ired
by th
e C
ourt.
(5)
pay
to th
e C
lerk
the
cost
s of
cou
rt an
d an
y ad
ditio
nal s
ums
show
n be
low
.
JUD
GM
ENT:
The
def
enda
nt a
ppea
red
in o
pen
cour
t and
free
ly, v
olun
taril
y an
d un
ders
tand
ingl
y en
tere
d th
e ab
ove
plea
; on
the
abov
e ve
rdic
t it i
s O
RD
ERED
that
the
defe
ndan
t:pa
y co
sts
and
a fin
e of
$.
be im
pris
oned
for a
term
of
days
in th
e cu
stod
y of
the
she
riff.
DO
C.*
Pre
trial
cre
dit
days
ser
ved.
Wor
k re
leas
eis
reco
mm
ende
d.is
not
reco
mm
ende
d.[
is
ord
ered
. (u
se fo
rm A
OC
-CR
-602
)]Th
e C
ourt
finds
that
alo
nger
shor
ter p
erio
d of
pro
batio
n, th
an th
at w
hich
is s
peci
fied
in G
.S. 1
5A-1
343.
2(d)
, is
nece
ssar
y.
$$
$$
$Fi
neR
estit
utio
n*A
ttorn
ey's
Fee
Com
mun
ity S
ervi
ce F
eeO
ther
Nam
e O
f Offi
cer (
Type
Or P
rint)
RET
UR
N O
F SE
RVI
CE
CER
TIFI
CA
TIO
N
APP
EAL
ENTR
IES
Dat
e S
igna
ture
Of D
istri
ct C
ourt
Judg
eN
ame
Of D
istri
ct C
ourt
Judg
e (T
ype
Or P
rint)
I cer
tify
that
this
Jud
gmen
t is
a tru
e an
d co
mpl
ete
copy
of t
he o
rigin
al w
hich
is o
n fil
e in
this
cas
e.D
ate
By
pers
onal
ly s
ervi
ng th
is C
rimin
al S
umm
ons
on th
e de
fend
ant.
RET
UR
N F
OLL
OW
ING
RED
ELIV
ERY/
REI
SSU
AN
CE
RED
ELIV
ERY/
REI
SSU
AN
CE
If D
WI,
use
AO
C-C
R-3
42 (a
ctiv
e) o
r AO
C-C
R-3
10 (p
roba
tion)
. If
activ
e se
nten
ce to
DO
C, u
se A
OC
-CR
-602
. If
supe
rvis
ed p
roba
tion,
us
e A
OC
-CR
-604
.
The
defe
ndan
t, in
ope
n co
urt,
give
s no
tice
of a
ppea
l to
the
Sup
erio
r Cou
rt.Th
e cu
rrent
pre
trial
rele
ase
orde
r is
mod
ified
as
follo
ws:
This
Crim
inal
Sum
mon
s W
AS
NO
T se
rved
for t
he fo
llow
ing
reas
on:
6. 7. 8. 9.
If th
is C
rimin
al S
umm
ons
is n
ot s
erve
d w
ithin
nin
ety
(90)
day
s, it
mus
t be
retu
rned
to th
e C
lerk
of C
ourt
in th
e co
unty
in w
hich
it w
as is
sued
with
the
reas
on fo
r the
failu
re o
f ser
vice
not
ed th
ereo
n. T
he o
ffice
r mus
t sta
te a
ll st
eps
take
n by
the
depa
rtmen
t in
atte
mpt
ing
to s
erve
the
Sum
mon
s an
d an
y in
form
atio
n ob
tain
ed a
bout
the
whe
reab
outs
of t
he d
efen
dant
.
I cer
tify
that
this
Crim
inal
Sum
mon
s w
as re
ceiv
ed a
nd s
erve
d as
fo
llow
s:
Sig
natu
re
. .
com
plet
e
h
ours
of c
omm
unity
ser
vice
dur
ing
the
first
day
s of
pro
batio
n, a
s di
rect
ed b
y th
e co
mm
unity
se
rvic
e co
ordi
nato
r, an
d pa
y th
e fe
e pr
escr
ibed
by
G.S
. 143
B-2
62.4
(b) w
ithin
day
s.no
t be
foun
d in
or o
n th
e pr
emis
es o
f the
com
plai
nant
or
.no
t ass
ault,
com
mun
icat
e w
ith o
r be
in th
e pr
esen
ce o
f the
com
plai
nant
or
.O
ther
:
This
Crim
inal
Sum
mon
s W
AS
NO
T se
rved
for t
he fo
llow
ing
reas
on:
CO
MM
ITM
ENT:
It i
s O
RD
ERED
that
the
Cle
rk d
eliv
er tw
o ce
rtifie
d co
pies
of t
his
Judg
men
t and
Com
mitm
ent t
o th
e sh
eriff
and
that
the
sher
iff c
ause
the
defe
ndan
t to
be re
tain
ed in
cus
tody
to s
erve
the
sent
ence
impo
sed
or u
ntil
the
defe
ndan
t sha
ll ha
ve c
ompl
ied
with
the
cond
ition
s of
rele
ase
pend
ing
appe
al.
It is
OR
DER
ED th
at th
is:
Judg
men
t is
cont
inue
d up
on p
aym
ent o
f cos
ts.
case
be
cons
olid
ated
for j
udgm
ent w
ithse
nten
ce is
to ru
n at
the
expi
ratio
n of
the
sent
ence
in
Sig
natu
re
Dep
. CS
C
Ass
ist.
CS
CC
SC
I cer
tify
that
this
Crim
inal
Sum
mon
s w
as re
ceiv
ed a
nd s
erve
d as
fo
llow
s:
By
pers
onal
ly s
ervi
ng th
is C
rimin
al S
umm
ons
on th
e de
fend
ant.
Sig
natu
re O
f Dis
trict
Cou
rt Ju
dge
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
Dep
artm
ent O
r Age
ncy
Of O
ffice
r
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
AOC
-CR
-113
, Sid
e Tw
o, R
ev. 3
/09
(Stru
ctur
ed S
ente
ncin
g)©
200
9 Ad
min
istra
tive
Offi
ce o
f the
Cou
rts*N
OTE
:
Dep
artm
ent O
r Age
ncy
Of O
ffice
r
Dat
e
Dat
e D
ate
Del
iver
ed T
o S
herif
f
AM PM
Tim
e S
erve
dD
ate
Rec
eive
dD
ate
Ser
ved
Dat
e R
etur
ned
Dat
e R
ecei
ved
Dat
e S
erve
dD
ate
Ret
urne
dAM PM
Tim
e S
erve
d
no c
onte
stno
con
test
no c
onte
st
App
oint
ed
Ret
aine
dW
aive
d
Not
Indi
gent
PRIO
R C
ON
VIC
TIO
NS:
No.
/Lev
el:
0I (
0)II
(1-4
)II
I (5+
)
Dis
trict
Atto
rney
Atto
rney
For
Def
enda
nt
guilt
ygu
ilty
guilt
yno
t gui
lty
2 2 2
1 1 1
3 3 3
A1 A1 A1
PLEA
:VE
RD
ICT:
M.C
L.M
.CL.
M.C
L.
File
No.
STA
TE O
F N
OR
TH C
AR
OLI
NA
Law
Enf
orce
men
t Cas
e N
o.LI
D N
o.
Cou
rt Ti
me
Cou
rt D
ate
Dat
e O
f Arr
est &
Che
ck D
igit
No.
(As
Sho
wn
On
Fing
erpr
int C
ard)
Com
plai
nant
(Nam
e, A
ddre
ss O
r Dep
artm
ent)
Mis
dem
eano
r Offe
nse
Whi
ch R
equi
res
Fing
erpr
intin
g Pe
r Fin
gerp
rint P
lan
Dat
e Is
sued
Driv
ers
Lice
nse
No.
& S
tate
Soc
ial S
ecur
ity N
o.
Nam
e O
f Def
enda
nt's
Em
ploy
er
Dat
e O
f Offe
nse
Offe
nse
Cod
e(s)
Offe
nse
In V
iola
tion
Of G
.S.
THE
STA
TE O
F N
OR
TH C
AR
OLI
NA
VS.
Nam
e A
nd A
ddre
ss O
f Def
enda
nt
Rac
eS
exD
ate
Of B
irth
Age
Offe
nse
To th
e de
fend
ant:
I, th
e un
ders
igne
d, fi
nd th
at th
ere
is p
roba
ble
caus
e to
bel
ieve
that
on
or a
bout
the
date
of o
ffens
e sh
own
and
in th
e co
unty
nam
ed a
bove
you
unl
awfu
lly a
nd w
illful
ly d
id
MIS
DEM
EAN
OR
CR
IMIN
AL
SUM
MO
NS
This
act
was
in v
iola
tion
of th
e la
w re
ferr
ed to
in th
is C
rimin
al S
umm
ons.
Thi
s Su
mm
ons
is is
sued
upo
n in
form
atio
n fu
rnis
hed
unde
r oat
h by
the
com
plai
nant
list
ed.
You
are
OR
DER
ED to
app
ear b
efor
e th
e C
ourt
at
the
loca
tion,
dat
e an
d tim
e in
dica
ted
belo
w to
ans
wer
to th
e ch
arge
. If
you
fail
to a
ppea
r, an
ord
er fo
r you
r ar
rest
may
be
issu
ed a
nd y
ou m
ay b
e he
ld in
CO
NTE
MPT
OF
CO
UR
T an
d im
pris
oned
for u
p to
thirt
y (3
0)
days
or f
ined
up
to $
500.
00 o
r bot
h. T
his
pena
lty fo
r fai
lure
to a
ppea
r is
in a
dditi
on to
any
sen
tenc
e w
hich
m
ay b
e im
pose
d fo
r the
crim
e ch
arge
d.
AO
C-C
R-1
13, R
ev. 3
/09
(Stru
ctur
ed S
ente
ncin
g)©
200
9 A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
Nam
es &
Add
ress
es O
f Witn
esse
s (In
clud
ing
Cou
ntie
s &
Tel
epho
ne N
os.)
In T
he G
ener
al C
ourt
Of J
ustic
e D
istri
ct C
ourt
Div
isio
nC
ount
y
Sig
natu
re
PM
AM
Dep
uty
CS
CC
lerk
Of S
uper
ior C
ourt
Mag
istra
te
Ass
ista
nt C
SC
Loca
tion
Of C
ourt
Loca
tion
Of C
ourt
SID
No.
FBI N
o.
Nam
e O
f Offi
cer (
Type
Or P
rint)
Dep
uty
CS
C
Ass
ist.
CS
C
C
SC
guilt
ygu
ilty
guilt
yno
t gui
lty
*Nam
e(s)
, add
ress
(es)
, am
ount
(s) &
soc
ial s
ecur
ity n
umbe
r(s)
of a
ggrie
ved
party
(ies)
to re
ceiv
e re
stitu
tion:
Exe
cutio
n of
the
sent
ence
is s
uspe
nded
and
the
defe
ndan
t is
plac
ed o
n un
supe
rvis
ed p
roba
tion*
for
mon
ths,
sub
ject
to th
e fo
llow
ing
cond
ition
s: (
1) c
omm
it no
crim
inal
offe
nse
in a
ny ju
risdi
ctio
n. (2
) pos
sess
no
firea
rm, e
xplo
sive
or o
ther
de
adly
wea
pon
liste
d in
G.S
. 14-
269.
(3)
rem
ain
gain
fully
and
sui
tabl
y em
ploy
ed o
r fai
thfu
lly p
ursu
e a
cour
se o
f stu
dy o
r of v
ocat
iona
l tra
inin
g, th
at w
ill e
quip
the
defe
ndan
t for
sui
tabl
e em
ploy
men
t, an
d ab
ide
by a
ll ru
les
of th
e in
stitu
tion.
(4)
sat
isfy
chi
ld s
uppo
rt an
d fa
mily
obl
igat
ions
, as
requ
ired
by th
e C
ourt.
(5)
pay
to th
e C
lerk
the
cost
s of
cou
rt an
d an
y ad
ditio
nal s
ums
show
n be
low
.
JUD
GM
ENT:
The
def
enda
nt a
ppea
red
in o
pen
cour
t and
free
ly, v
olun
taril
y an
d un
ders
tand
ingl
y en
tere
d th
e ab
ove
plea
; on
the
abov
e ve
rdic
t it i
s O
RD
ERED
that
the
defe
ndan
t:pa
y co
sts
and
a fin
e of
$.
be im
pris
oned
for a
term
of
days
in th
e cu
stod
y of
the
she
riff.
DO
C.*
Pre
trial
cre
dit
days
ser
ved.
Wor
k re
leas
eis
reco
mm
ende
d.is
not
reco
mm
ende
d.[
is
ord
ered
. (u
se fo
rm A
OC
-CR
-602
)]Th
e C
ourt
finds
that
alo
nger
shor
ter p
erio
d of
pro
batio
n, th
an th
at w
hich
is s
peci
fied
in G
.S. 1
5A-1
343.
2(d)
, is
nece
ssar
y.
$$
$$
$Fi
neR
estit
utio
n*A
ttorn
ey's
Fee
Com
mun
ity S
ervi
ce F
eeO
ther
Nam
e O
f Offi
cer (
Type
Or P
rint)
RET
UR
N O
F SE
RVI
CE
CER
TIFI
CA
TIO
N
APP
EAL
ENTR
IES
Dat
e S
igna
ture
Of D
istri
ct C
ourt
Judg
eN
ame
Of D
istri
ct C
ourt
Judg
e (T
ype
Or P
rint)
I cer
tify
that
this
Jud
gmen
t is
a tru
e an
d co
mpl
ete
copy
of t
he o
rigin
al w
hich
is o
n fil
e in
this
cas
e.D
ate
By
pers
onal
ly s
ervi
ng th
is C
rimin
al S
umm
ons
on th
e de
fend
ant.
RET
UR
N F
OLL
OW
ING
RED
ELIV
ERY/
REI
SSU
AN
CE
RED
ELIV
ERY/
REI
SSU
AN
CE
If D
WI,
use
AO
C-C
R-3
42 (a
ctiv
e) o
r AO
C-C
R-3
10 (p
roba
tion)
. If
activ
e se
nten
ce to
DO
C, u
se A
OC
-CR
-602
. If
supe
rvis
ed p
roba
tion,
us
e A
OC
-CR
-604
.
The
defe
ndan
t, in
ope
n co
urt,
give
s no
tice
of a
ppea
l to
the
Sup
erio
r Cou
rt.Th
e cu
rrent
pre
trial
rele
ase
orde
r is
mod
ified
as
follo
ws:
This
Crim
inal
Sum
mon
s W
AS
NO
T se
rved
for t
he fo
llow
ing
reas
on:
6. 7. 8. 9.
If th
is C
rimin
al S
umm
ons
is n
ot s
erve
d w
ithin
nin
ety
(90)
day
s, it
mus
t be
retu
rned
to th
e C
lerk
of C
ourt
in th
e co
unty
in w
hich
it w
as is
sued
with
the
reas
on fo
r the
failu
re o
f ser
vice
not
ed th
ereo
n. T
he o
ffice
r mus
t sta
te a
ll st
eps
take
n by
the
depa
rtmen
t in
atte
mpt
ing
to s
erve
the
Sum
mon
s an
d an
y in
form
atio
n ob
tain
ed a
bout
the
whe
reab
outs
of t
he d
efen
dant
.
I cer
tify
that
this
Crim
inal
Sum
mon
s w
as re
ceiv
ed a
nd s
erve
d as
fo
llow
s:
Sig
natu
re
. .
com
plet
e
h
ours
of c
omm
unity
ser
vice
dur
ing
the
first
day
s of
pro
batio
n, a
s di
rect
ed b
y th
e co
mm
unity
se
rvic
e co
ordi
nato
r, an
d pa
y th
e fe
e pr
escr
ibed
by
G.S
. 143
B-2
62.4
(b) w
ithin
day
s.no
t be
foun
d in
or o
n th
e pr
emis
es o
f the
com
plai
nant
or
.no
t ass
ault,
com
mun
icat
e w
ith o
r be
in th
e pr
esen
ce o
f the
com
plai
nant
or
.O
ther
:
This
Crim
inal
Sum
mon
s W
AS
NO
T se
rved
for t
he fo
llow
ing
reas
on:
CO
MM
ITM
ENT:
It i
s O
RD
ERED
that
the
Cle
rk d
eliv
er tw
o ce
rtifie
d co
pies
of t
his
Judg
men
t and
Com
mitm
ent t
o th
e sh
eriff
and
that
the
sher
iff c
ause
the
defe
ndan
t to
be re
tain
ed in
cus
tody
to s
erve
the
sent
ence
impo
sed
or u
ntil
the
defe
ndan
t sha
ll ha
ve c
ompl
ied
with
the
cond
ition
s of
rele
ase
pend
ing
appe
al.
It is
OR
DER
ED th
at th
is:
Judg
men
t is
cont
inue
d up
on p
aym
ent o
f cos
ts.
case
be
cons
olid
ated
for j
udgm
ent w
ithse
nten
ce is
to ru
n at
the
expi
ratio
n of
the
sent
ence
in
Sig
natu
re
Dep
. CS
C
Ass
ist.
CS
CC
SC
I cer
tify
that
this
Crim
inal
Sum
mon
s w
as re
ceiv
ed a
nd s
erve
d as
fo
llow
s:
By
pers
onal
ly s
ervi
ng th
is C
rimin
al S
umm
ons
on th
e de
fend
ant.
Sig
natu
re O
f Dis
trict
Cou
rt Ju
dge
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
Dep
artm
ent O
r Age
ncy
Of O
ffice
r
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
AOC
-CR
-113
, Sid
e Tw
o, R
ev. 3
/09
(Stru
ctur
ed S
ente
ncin
g)©
200
9 Ad
min
istra
tive
Offi
ce o
f the
Cou
rts*N
OTE
:
Dep
artm
ent O
r Age
ncy
Of O
ffice
r
Dat
e
Dat
e D
ate
Del
iver
ed T
o S
herif
f
AM PM
Tim
e S
erve
dD
ate
Rec
eive
dD
ate
Ser
ved
Dat
e R
etur
ned
Dat
e R
ecei
ved
Dat
e S
erve
dD
ate
Ret
urne
dAM PM
Tim
e S
erve
d
no c
onte
stno
con
test
no c
onte
st
App
oint
ed
Ret
aine
dW
aive
d
Not
Indi
gent
PRIO
R C
ON
VIC
TIO
NS:
No.
/Lev
el:
0I (
0)II
(1-4
)II
I (5+
)
Dis
trict
Atto
rney
Atto
rney
For
Def
enda
nt
guilt
ygu
ilty
guilt
yno
t gui
lty
2 2 2
1 1 1
3 3 3
A1 A1 A1
PLEA
:VE
RD
ICT:
M.C
L.M
.CL.
M.C
L.
File
No.
STA
TE O
F N
OR
TH C
AR
OLI
NA
Law
Enf
orce
men
t Cas
e N
o.
Cou
rt Ti
me
AO
C-C
R-1
16, R
ev. 3
/09
(Stru
ctur
ed S
ente
ncin
g)©
200
9 A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
Mis
dem
eano
r Offe
nse
Whi
ch R
equi
res
Fing
erpr
intin
g Pe
r Fin
gerp
rint P
lan
MA
GIS
TRA
TE'S
OR
DER
THE
STA
TE O
F N
OR
TH C
AR
OLI
NA
VS.
Offe
nse
Nam
e A
nd A
ddre
ss O
f Def
enda
nt
In T
he G
ener
al C
ourt
Of J
ustic
e D
istri
ct C
ourt
Div
isio
nC
ount
y
FBI N
o.LI
D N
o.S
ID N
o.
Dat
e O
f Offe
nse
Nam
es &
Add
ress
es O
f Witn
esse
s (In
clud
ing
Cou
ntie
s &
Tel
epho
ne N
os.)
Dat
e O
f Arr
est &
Che
ck D
igit
No.
(As
Sho
wn
On
Fing
erpr
int C
ard)
Arr
estin
g O
ffice
r (N
ame,
Add
ress
Or D
epar
tmen
t)
Dat
e Is
sued
Nam
e O
f Def
enda
nt's
Em
ploy
er
Offe
nse
Cod
e(s)
Offe
nse
In V
iola
tion
Of G
.S.
Rac
eS
exD
ate
Of B
irth
Age
Soc
ial S
ecur
ity N
o.D
river
s Li
cens
e N
o. &
Sta
te
Sig
natu
re
PM
AM
Dep
uty
CS
CC
lerk
Of S
uper
ior C
ourt
Mag
istra
te
Ass
ista
nt C
SC
Loca
tion
Of C
ourt
Cou
rt D
ate
This
act
was
in v
iola
tion
of th
e la
w re
ferr
ed to
in th
is M
agis
trate
's O
rder
. Thi
s M
agis
trate
's O
rder
is is
sued
up
on in
form
atio
n fu
rnis
hed
unde
r oat
h by
the
arre
stin
g of
ficer
(s) s
how
n. A
cop
y of
this
Ord
er h
as b
een
deliv
ered
to th
e de
fend
ant.
I, th
e un
ders
igne
d, fi
nd th
at th
e de
fend
ant n
amed
abo
ve h
as b
een
arre
sted
with
out a
w
arra
nt a
nd th
e de
fend
ant's
det
entio
n is
just
ified
bec
ause
ther
e is
pro
babl
e ca
use
to
belie
ve th
at o
n or
abo
ut th
e da
te o
f offe
nse
show
n an
d in
the
coun
ty n
amed
abo
ve th
e de
fend
ant n
amed
ab
ove
unla
wfu
lly, w
illful
ly a
nd fe
loni
ousl
y di
d
Dep
uty
CS
C
Ass
ist.
CS
C
C
SC
$$
The
Cou
rt fin
ds th
at a
lon
ger
sho
rter p
erio
d of
pro
batio
n, th
an th
at w
hich
is s
peci
fied
in G
.S. 1
5A-1
343.
2(d)
, is
nece
ssar
y.
Wor
k re
leas
e
i
s re
com
men
ded.
is
not
reco
mm
ende
d.
[
is
orde
red.
(use
form
AO
C-C
R-6
02)]
be im
pris
oned
for a
term
of
da
ys in
the
cust
ody
of
t
he s
herif
f.
DO
C.*
Pre
trial
cre
dit
d
ays
serv
ed.
*Nam
e(s)
, add
ress
(es)
, am
ount
(s) &
soc
ial s
ecur
ity n
umbe
r(s)
of a
ggrie
ved
party
(ies)
to re
ceiv
e re
stitu
tion:
Exe
cutio
n of
the
sent
ence
is s
uspe
nded
and
the
defe
ndan
t is
plac
ed o
n un
supe
rvis
ed p
roba
tion*
for
mon
ths,
sub
ject
to th
e fo
llow
ing
cond
ition
s: (
1) c
omm
it no
crim
inal
offe
nse
in a
ny ju
risdi
ctio
n. (
2) p
osse
ss n
o fir
earm
, exp
losi
ve o
r oth
er d
eadl
y w
eapo
n lis
ted
in G
.S. 1
4-26
9. (
3) re
mai
n ga
infu
lly a
nd s
uita
bly
empl
oyed
or f
aith
fully
pur
sue
a co
urse
of s
tudy
or o
f voc
atio
nal t
rain
ing,
that
will
equ
ip
the
defe
ndan
t for
sui
tabl
e em
ploy
men
t, an
d ab
ide
by a
ll ru
les
of th
e in
stitu
tion.
(4)
sat
isfy
chi
ld s
uppo
rt an
d fa
mily
obl
igat
ions
, as
requ
ired
by th
e C
ourt.
(5)
pay
to th
e C
lerk
the
cost
s of
cou
rt an
d an
y ad
ditio
nal s
ums
show
n be
low
.
JUD
GM
ENT:
The
def
enda
nt a
ppea
red
in o
pen
cour
t and
free
ly, v
olun
taril
y an
d un
ders
tand
ingl
y en
tere
d th
e ab
ove
plea
; on
the
abov
e ve
rdic
t, it
is O
RD
ERED
that
the
defe
ndan
t:
p
ay c
osts
and
a fi
ne o
f $
.
$$
$
Fine
Res
titut
ion*
Atto
rney
's F
eeC
omm
unity
Ser
vice
Fee
Oth
er
com
plet
e
h
ours
of c
omm
unity
ser
vice
dur
ing
the
first
day
s of
pro
batio
n, a
s di
rect
ed b
y th
e co
mm
unity
se
rvic
e co
ordi
nato
r, an
d pa
y th
e fe
e pr
escr
ibed
by
G.S
. 143
B-2
62.4
(b) w
ithin
day
s.
APP
EAL
ENTR
IES
WA
IVER
OF
PRO
BA
BLE
CA
USE
HEA
RIN
G
The
defe
ndan
t, in
ope
n co
urt,
give
s no
tice
of a
ppea
l to
the
The
curre
nt p
retri
al re
leas
e or
der i
s m
odifi
ed a
s fo
llow
s:
Sig
natu
re O
f Dis
trict
Cou
rt Ju
dge
Or M
agis
trate
The
unde
rsig
ned
defe
ndan
t, w
ith th
e co
nsen
t of h
is/h
er a
ttorn
ey, w
aive
s th
e rig
ht to
a p
roba
ble
caus
e he
arin
g.S
igna
ture
Of D
efen
dant
Sig
natu
re O
f Atto
rney
Dis
trict
Sup
erio
r C
ourt.
AOC
-CR
-116
, Sid
e Tw
o, R
ev. 3
/09
(Stru
ctur
ed S
ente
ncin
g)*N
OTE
:If
DW
I, us
e A
OC
-CR
-342
(act
ive)
or A
OC
-CR
-310
(pro
batio
n). I
f act
ive
sent
ence
to D
OC
, use
AO
C-C
R-6
02.
If su
perv
ised
pro
batio
n,
use
AO
C-C
R-6
04.
© 2
009A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
Dat
e W
aive
d
Dat
e
prov
ide
a D
NA
sam
ple
purs
uant
to G
.S. 1
5A-2
66.4
. (A
OC
-CR
-319
)
6. 7.no
t be
foun
d in
or o
n th
e pr
emis
es o
f the
com
plai
nant
or
.
8.no
t ass
ault,
com
mun
icat
e w
ith o
r be
in th
e pr
esen
ce o
f the
com
plai
nant
or
.
sent
ence
is to
run
at th
e ex
pira
tion
of th
e se
nten
ce in
It is
OR
DER
ED t
hat
this
:Ju
dgm
ent i
s co
ntin
ued
upon
pay
men
t of c
osts
.ca
se b
e co
nsol
idat
ed fo
r jud
gmen
t with
. .
9. 10.
Oth
er:
Dat
e
CER
TIFI
CA
TIO
NI c
ertif
y th
at th
is J
udgm
ent i
s a
true
and
com
plet
e co
py o
f the
orig
inal
whi
ch is
on
file
in th
is c
ase.
CO
MM
ITM
ENT:
It i
s O
RD
ERED
that
the
Cle
rk d
eliv
er tw
o ce
rtifie
d co
pies
of t
his
Judg
men
t and
Com
mitm
ent t
o th
e sh
eriff
and
that
the
sher
iff c
ause
the
defe
ndan
t to
be re
tain
ed in
cus
tody
to s
erve
the
sent
ence
impo
sed
or u
ntil
the
defe
ndan
t sha
ll ha
ve c
ompl
ied
with
the
cond
ition
s of
rele
ase
pend
ing
appe
al.
Sig
natu
re
PRO
BA
BLE
CA
USE
:
Pro
babl
e ca
use
is fo
und
as to
all
Cou
nts
exce
pt
,
and
the
defe
ndan
t is
boun
d ov
er to
Sup
erio
r C
ourt
for a
ctio
n by
the
gran
d ju
ry.
N
o pr
obab
le c
ause
is fo
und
as to
Cou
nt(s
)
of t
his
Mag
istra
te's
Ord
er a
nd th
e C
ount
(s)
is d
ism
isse
d.S
igna
ture
Of D
istri
ct C
ourt
Judg
e O
r Mag
istra
teD
ate
Dat
e D
eliv
ered
To
She
riff
Nam
e O
f Dis
trict
Cou
rt Ju
dge
Or M
agis
trate
(Typ
e O
r Prin
t)
guilt
ygu
ilty
guilt
yno
t gui
lty
no c
onte
stno
con
test
no c
onte
st
App
oint
ed
Ret
aine
dW
aive
d
Not
Indi
gent
PRIO
R C
ON
VIC
TIO
NS:
No.
/Lev
el:
0I (
0)II
(1-4
)II
I (5+
)
Dis
trict
Atto
rney
Atto
rney
For
Def
enda
nt
guilt
ygu
ilty
guilt
yno
t gui
lty
2 2 2
1 1 1
3 3 3
A1 A1 A1
PLEA
:VE
RD
ICT:
M.C
L.M
.CL.
M.C
L.
File
No.
STA
TE O
F N
OR
TH C
AR
OLI
NA
Law
Enf
orce
men
t Cas
e N
o.
Cou
rt Ti
me
AO
C-C
R-1
16, R
ev. 3
/09
(Stru
ctur
ed S
ente
ncin
g)©
200
9 A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
Mis
dem
eano
r Offe
nse
Whi
ch R
equi
res
Fing
erpr
intin
g Pe
r Fin
gerp
rint P
lan
MA
GIS
TRA
TE'S
OR
DER
THE
STA
TE O
F N
OR
TH C
AR
OLI
NA
VS.
Offe
nse
Nam
e A
nd A
ddre
ss O
f Def
enda
nt
In T
he G
ener
al C
ourt
Of J
ustic
e D
istri
ct C
ourt
Div
isio
nC
ount
y
FBI N
o.LI
D N
o.S
ID N
o.
Dat
e O
f Offe
nse
Nam
es &
Add
ress
es O
f Witn
esse
s (In
clud
ing
Cou
ntie
s &
Tel
epho
ne N
os.)
Dat
e O
f Arr
est &
Che
ck D
igit
No.
(As
Sho
wn
On
Fing
erpr
int C
ard)
Arr
estin
g O
ffice
r (N
ame,
Add
ress
Or D
epar
tmen
t)
Dat
e Is
sued
Nam
e O
f Def
enda
nt's
Em
ploy
er
Offe
nse
Cod
e(s)
Offe
nse
In V
iola
tion
Of G
.S.
Rac
eS
exD
ate
Of B
irth
Age
Soc
ial S
ecur
ity N
o.D
river
s Li
cens
e N
o. &
Sta
te
Sig
natu
re
PM
AM
Dep
uty
CS
CC
lerk
Of S
uper
ior C
ourt
Mag
istra
te
Ass
ista
nt C
SC
Loca
tion
Of C
ourt
Cou
rt D
ate
This
act
was
in v
iola
tion
of th
e la
w re
ferr
ed to
in th
is M
agis
trate
's O
rder
. Thi
s M
agis
trate
's O
rder
is is
sued
up
on in
form
atio
n fu
rnis
hed
unde
r oat
h by
the
arre
stin
g of
ficer
(s) s
how
n. A
cop
y of
this
Ord
er h
as b
een
deliv
ered
to th
e de
fend
ant.
I, th
e un
ders
igne
d, fi
nd th
at th
e de
fend
ant n
amed
abo
ve h
as b
een
arre
sted
with
out a
w
arra
nt a
nd th
e de
fend
ant's
det
entio
n is
just
ified
bec
ause
ther
e is
pro
babl
e ca
use
to
belie
ve th
at o
n or
abo
ut th
e da
te o
f offe
nse
show
n an
d in
the
coun
ty n
amed
abo
ve th
e de
fend
ant n
amed
ab
ove
unla
wfu
lly, w
illful
ly a
nd fe
loni
ousl
y di
d
Dep
uty
CS
C
Ass
ist.
CS
C
C
SC
$$
The
Cou
rt fin
ds th
at a
lon
ger
sho
rter p
erio
d of
pro
batio
n, th
an th
at w
hich
is s
peci
fied
in G
.S. 1
5A-1
343.
2(d)
, is
nece
ssar
y.
Wor
k re
leas
e
i
s re
com
men
ded.
is
not
reco
mm
ende
d.
[
is
orde
red.
(use
form
AO
C-C
R-6
02)]
be im
pris
oned
for a
term
of
da
ys in
the
cust
ody
of
t
he s
herif
f.
DO
C.*
Pre
trial
cre
dit
d
ays
serv
ed.
*Nam
e(s)
, add
ress
(es)
, am
ount
(s) &
soc
ial s
ecur
ity n
umbe
r(s)
of a
ggrie
ved
party
(ies)
to re
ceiv
e re
stitu
tion:
Exe
cutio
n of
the
sent
ence
is s
uspe
nded
and
the
defe
ndan
t is
plac
ed o
n un
supe
rvis
ed p
roba
tion*
for
mon
ths,
sub
ject
to th
e fo
llow
ing
cond
ition
s: (
1) c
omm
it no
crim
inal
offe
nse
in a
ny ju
risdi
ctio
n. (
2) p
osse
ss n
o fir
earm
, exp
losi
ve o
r oth
er d
eadl
y w
eapo
n lis
ted
in G
.S. 1
4-26
9. (
3) re
mai
n ga
infu
lly a
nd s
uita
bly
empl
oyed
or f
aith
fully
pur
sue
a co
urse
of s
tudy
or o
f voc
atio
nal t
rain
ing,
that
will
equ
ip
the
defe
ndan
t for
sui
tabl
e em
ploy
men
t, an
d ab
ide
by a
ll ru
les
of th
e in
stitu
tion.
(4)
sat
isfy
chi
ld s
uppo
rt an
d fa
mily
obl
igat
ions
, as
requ
ired
by th
e C
ourt.
(5)
pay
to th
e C
lerk
the
cost
s of
cou
rt an
d an
y ad
ditio
nal s
ums
show
n be
low
.
JUD
GM
ENT:
The
def
enda
nt a
ppea
red
in o
pen
cour
t and
free
ly, v
olun
taril
y an
d un
ders
tand
ingl
y en
tere
d th
e ab
ove
plea
; on
the
abov
e ve
rdic
t, it
is O
RD
ERED
that
the
defe
ndan
t:
p
ay c
osts
and
a fi
ne o
f $
.
$$
$
Fine
Res
titut
ion*
Atto
rney
's F
eeC
omm
unity
Ser
vice
Fee
Oth
er
com
plet
e
h
ours
of c
omm
unity
ser
vice
dur
ing
the
first
day
s of
pro
batio
n, a
s di
rect
ed b
y th
e co
mm
unity
se
rvic
e co
ordi
nato
r, an
d pa
y th
e fe
e pr
escr
ibed
by
G.S
. 143
B-2
62.4
(b) w
ithin
day
s.
APP
EAL
ENTR
IES
WA
IVER
OF
PRO
BA
BLE
CA
USE
HEA
RIN
G
The
defe
ndan
t, in
ope
n co
urt,
give
s no
tice
of a
ppea
l to
the
The
curre
nt p
retri
al re
leas
e or
der i
s m
odifi
ed a
s fo
llow
s:
Sig
natu
re O
f Dis
trict
Cou
rt Ju
dge
Or M
agis
trate
The
unde
rsig
ned
defe
ndan
t, w
ith th
e co
nsen
t of h
is/h
er a
ttorn
ey, w
aive
s th
e rig
ht to
a p
roba
ble
caus
e he
arin
g.S
igna
ture
Of D
efen
dant
Sig
natu
re O
f Atto
rney
Dis
trict
Sup
erio
r C
ourt.
AOC
-CR
-116
, Sid
e Tw
o, R
ev. 3
/09
(Stru
ctur
ed S
ente
ncin
g)*N
OTE
:If
DW
I, us
e A
OC
-CR
-342
(act
ive)
or A
OC
-CR
-310
(pro
batio
n). I
f act
ive
sent
ence
to D
OC
, use
AO
C-C
R-6
02.
If su
perv
ised
pro
batio
n,
use
AO
C-C
R-6
04.
© 2
009A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
Dat
e W
aive
d
Dat
e
prov
ide
a D
NA
sam
ple
purs
uant
to G
.S. 1
5A-2
66.4
. (A
OC
-CR
-319
)
6. 7.no
t be
foun
d in
or o
n th
e pr
emis
es o
f the
com
plai
nant
or
.
8.no
t ass
ault,
com
mun
icat
e w
ith o
r be
in th
e pr
esen
ce o
f the
com
plai
nant
or
.
sent
ence
is to
run
at th
e ex
pira
tion
of th
e se
nten
ce in
It is
OR
DER
ED t
hat
this
:Ju
dgm
ent i
s co
ntin
ued
upon
pay
men
t of c
osts
.ca
se b
e co
nsol
idat
ed fo
r jud
gmen
t with
. .
9. 10.
Oth
er:
Dat
e
CER
TIFI
CA
TIO
NI c
ertif
y th
at th
is J
udgm
ent i
s a
true
and
com
plet
e co
py o
f the
orig
inal
whi
ch is
on
file
in th
is c
ase.
CO
MM
ITM
ENT:
It i
s O
RD
ERED
that
the
Cle
rk d
eliv
er tw
o ce
rtifie
d co
pies
of t
his
Judg
men
t and
Com
mitm
ent t
o th
e sh
eriff
and
that
the
sher
iff c
ause
the
defe
ndan
t to
be re
tain
ed in
cus
tody
to s
erve
the
sent
ence
impo
sed
or u
ntil
the
defe
ndan
t sha
ll ha
ve c
ompl
ied
with
the
cond
ition
s of
rele
ase
pend
ing
appe
al.
Sig
natu
re
PRO
BA
BLE
CA
USE
:
Pro
babl
e ca
use
is fo
und
as to
all
Cou
nts
exce
pt
,
and
the
defe
ndan
t is
boun
d ov
er to
Sup
erio
r C
ourt
for a
ctio
n by
the
gran
d ju
ry.
N
o pr
obab
le c
ause
is fo
und
as to
Cou
nt(s
)
of t
his
Mag
istra
te's
Ord
er a
nd th
e C
ount
(s)
is d
ism
isse
d.S
igna
ture
Of D
istri
ct C
ourt
Judg
e O
r Mag
istra
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ate
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e D
eliv
ered
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riff
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e O
f Dis
trict
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rt Ju
dge
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agis
trate
(Typ
e O
r Prin
t)
guilt
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ilty
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yno
t gui
lty
no c
onte
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con
test
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onte
st
App
oint
ed
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aine
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aive
d
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gent
PRIO
R C
ON
VIC
TIO
NS:
No.
/Lev
el:
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)
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trict
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rney
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rney
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enda
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ilty
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lty
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:VE
RD
ICT:
M.C
L.M
.CL.
M.C
L.
RET
UR
N O
F SE
RVI
CE
I mad
e a
sear
ch o
f
AM
File
No.
(Ove
r)
SEA
RC
H W
AR
RA
NT
STA
TEO
F N
OR
TH C
AR
OLI
NA
In T
he G
ener
al C
ourt
Of J
ustic
eD
istri
ct/S
uper
ior C
ourt
Div
isio
nC
ount
y
To a
ny o
ffice
r with
aut
horit
y an
d ju
risdi
ctio
n to
con
duct
the
sear
ch a
utho
rized
by
this
Sea
rch
War
rant
:
I, th
e un
ders
igne
d, fi
nd th
at th
ere
is p
roba
ble
caus
e to
bel
ieve
that
the
prop
erty
and
per
son
desc
ribed
in th
eap
plic
atio
n on
the
reve
rse
side
and
rela
ted
to th
e co
mm
issi
on o
f a c
rime
is lo
cate
d as
des
crib
ed in
the
appl
icat
ion.
You
are
com
man
ded
to s
earc
h th
e pr
emis
es, v
ehic
le, p
erso
n an
d ot
her p
lace
or i
tem
des
crib
ed in
the
appl
icat
ion
for t
he p
rope
rty a
nd p
erso
n in
que
stio
n. I
f the
pro
perty
and
/or p
erso
n ar
e fo
und,
mak
e th
e se
izur
ean
d ke
ep th
e pr
oper
ty s
ubje
ct to
Cou
rt O
rder
and
pro
cess
the
pers
on a
ccor
ding
to la
w.
You
are
dire
cted
to e
xecu
te th
is S
earc
h W
arra
nt w
ithin
forty
-eig
ht (4
8) h
ours
from
the
time
indi
cate
d on
this
War
rant
and
mak
e du
e re
turn
to th
e C
lerk
of t
he Is
suin
g C
ourt.
This
Sea
rch
War
rant
is is
sued
upo
n in
form
atio
n fu
rnis
hed
unde
r oat
h or
affi
rmat
ion
by th
e pe
rson
(s) s
how
n.
IN T
HE
MA
TTER
OF
AO
C-C
R-1
19, R
ev. 6
/12
Nam
e O
f App
lican
t
Dat
e Is
sued
Tim
e Is
sued
PM
Nam
e O
f Add
ition
al A
ffian
t
I cer
tify
that
this
Sea
rch
War
rant
was
rece
ived
and
exec
uted
as
follo
ws:
Dat
e R
ecei
ved
Dat
e E
xecu
ted
as c
omm
ande
d.
I sei
zed
the
item
s lis
ted
on th
e at
tach
edin
vent
ory .
I did
not
sei
ze a
ny it
ems.
This
War
rant
WA
S N
OT
exec
uted
with
info
rty-e
ight
(48)
hou
rs o
f the
dat
e of
issu
ance
and
I her
eby
retu
rn it
not
exe
cute
d.
AM
PMA
MTi
me
Exe
cute
d
Tim
e R
ecei
ved
PM
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
Incid
ent N
umbe
rD
epar
tmen
t Or A
genc
y O
f Offi
cer
Dep
uty
CS
CM
agis
trate
Nam
e (T
ype
Or P
rint)
Dat
e
Assi
stan
t CS
CD
istri
ct C
t. Ju
dge
CSC
Sup
erio
r Ct.
Judg
e
© 2
012
Adm
inis
trativ
e O
ffice
of t
he C
ourts
Nam
e O
f Add
ition
al A
ffian
t
Nam
e O
f Offi
cer M
akin
g R
etur
n (T
ype
Or P
rint)
Nam
e O
f Cle
rk (T
ype
Or P
rint)
Dat
eTi
me
AM
PM
This
Sea
rch
War
rant
was
retu
rned
to th
e un
ders
igne
d cl
erk
on th
e da
te a
nd ti
me
show
n be
low
.
Dep
CSC
CS
CAs
st C
SC
This
Sea
rch
War
rant
was
del
iver
ed to
me
on th
e da
te a
nd a
t the
tim
e sh
own
belo
w w
hen
the
Offi
ce o
f the
Cle
rk
of S
uper
ior C
ourt
is c
lose
d fo
r the
tran
sact
ion
of b
usin
ess.
By
sign
ing
belo
w, I
cer
tify
that
I w
ill d
eliv
er th
isS
earc
h W
arra
nt to
the
Offi
ce o
f the
Cle
rk o
f Sup
erio
r Cou
rt as
soo
n as
pos
sibl
e on
the
Cle
rk’s
nex
t bus
ines
s da
y.
Dat
eTi
me
AM
PMN
ame
Of M
agis
trate
(Typ
e O
r Prin
t)S
igna
ture
Of M
agis
trate
Sig
natu
re
Sig
natu
re O
f Cle
rk
Forms-Pg 13
bein
g du
ly s
wor
n, re
ques
t tha
t the
Cou
rt is
sue
a w
arra
nt to
sea
rch
the
pers
on,
plac
e, v
ehic
le, a
nd o
ther
item
s de
scrib
ed in
this
app
licat
ion
and
to fi
nd a
nd s
eize
the
prop
erty
and
per
son
desc
ribed
in th
is a
pplic
atio
n. T
here
is p
roba
ble
caus
e to
belie
ve th
at (D
escr
ibe
prop
erty
to b
e se
ized
; or i
f sea
rch
war
rant
is to
be
used
for s
earc
hing
a
plac
e to
ser
ve a
n ar
rest
war
rant
or
othe
r pr
oces
s, n
ame
pers
on to
be
arre
sted
)
inth
efo
llow
ing
prem
ises
(Giv
e ad
dres
s an
d, if
use
ful,
desc
ribe
prem
ises
)
tape
reco
rded
and
I ha
ve fi
led
each
with
the
clre
k.
In a
dditi
on to
the
affid
avit
incl
uded
abo
ve, t
his
appl
icat
ion
is s
uppo
rted
byad
ditio
nal a
ffida
vits
, atta
ched
, mad
e by
(Inse
rt na
me
and
addr
ess;
or i
f law
enf
orce
men
t offi
cer,
nam
e, ra
nk a
nd a
genc
y)
I, (and
)
APP
LIC
ATI
ON
FO
R S
EAR
CH
WA
RR
AN
T
The
appl
ican
t sw
ears
or a
ffirm
s to
the
follo
win
g fa
cts
to e
stab
lish
prob
able
cau
se
for t
he is
suan
ce o
f a s
earc
h w
arra
nt:
Mag
istra
teJu
dge
Dep
. CS
CC
lerk
Of S
uprio
r Cou
rt
eA
sst.
CS
C
Sig
natu
re
SWO
RN
/AFF
IRM
ED A
ND
SU
SCR
IBED
TO
BEF
OR
E M
E
This
test
imon
y ha
s be
en (c
heck
app
ropr
iate
box
)re
duce
d to
writ
ing
Dat
e
onth
efo
llow
ing
pers
on(s
) (G
ive
nam
e(s)
and
, if u
sefu
l, de
scrib
e pe
rson
(s))
(and
) inth
efo
llow
ing
vehi
cle(
s) (D
escr
ibe
vehi
cle(
s))
AO
C-C
R-1
19, R
ev. 6
/12
cons
titut
es e
vide
nce
of a
crim
e an
d th
e id
entit
y of
a p
erso
n pa
rtici
patin
g in
acr
ime,
(Nam
e cr
ime)
and
is lo
cate
d (C
heck
app
ropr
iate
box
(es)
and
fill-
in s
peci
fied
info
rmat
ion)
,,(a
nd) (N
ame
and/
or d
escr
ibe
othe
r pla
ces
or it
ems
to b
e se
arch
ed, i
f app
licab
le)
In a
dditi
on to
the
affid
avit
incl
uded
abo
ve, t
his
appl
icat
ion
is s
uppo
rted
bysw
orn
test
imon
y, g
iven
by
NO
TE:
If m
ore
spac
e is
nee
ded
for a
ny s
ectio
n, c
ontin
ue th
e st
atem
ent o
n an
atta
ched
shee
t of p
aper
with
a n
otat
ion
sayi
ng “s
ee a
ttach
men
t.” D
ate
the
cont
inua
tion
and
incl
ude
on it
the
sign
atur
es o
f app
lican
t and
issu
ing
offic
ial.
© 2
012
Adm
inis
trativ
e O
ffice
of t
he C
ourts
.
Nam
e O
f App
lican
t (Ty
pe O
r Prin
t)
Date
Sig
natu
re O
f App
lican
t
Forms-Pg 14
RET
UR
N O
F SE
RVI
CE
I mad
e a
sear
ch o
f
AM
File
No.
(Ove
r)
SEA
RC
H W
AR
RA
NT
STA
TEO
F N
OR
TH C
AR
OLI
NA
In T
he G
ener
al C
ourt
Of J
ustic
eD
istri
ct/S
uper
ior C
ourt
Div
isio
nC
ount
y
To a
ny o
ffice
r with
aut
horit
y an
d ju
risdi
ctio
n to
con
duct
the
sear
ch a
utho
rized
by
this
Sea
rch
War
rant
:
I, th
e un
ders
igne
d, fi
nd th
at th
ere
is p
roba
ble
caus
e to
bel
ieve
that
the
prop
erty
and
per
son
desc
ribed
in th
eap
plic
atio
n on
the
reve
rse
side
and
rela
ted
to th
e co
mm
issi
on o
f a c
rime
is lo
cate
d as
des
crib
ed in
the
appl
icat
ion.
You
are
com
man
ded
to s
earc
h th
e pr
emis
es, v
ehic
le, p
erso
n an
d ot
her p
lace
or i
tem
des
crib
ed in
the
appl
icat
ion
for t
he p
rope
rty a
nd p
erso
n in
que
stio
n. I
f the
pro
perty
and
/or p
erso
n ar
e fo
und,
mak
e th
e se
izur
ean
d ke
ep th
e pr
oper
ty s
ubje
ct to
Cou
rt O
rder
and
pro
cess
the
pers
on a
ccor
ding
to la
w.
You
are
dire
cted
to e
xecu
te th
is S
earc
h W
arra
nt w
ithin
forty
-eig
ht (4
8) h
ours
from
the
time
indi
cate
d on
this
War
rant
and
mak
e du
e re
turn
to th
e C
lerk
of t
he Is
suin
g C
ourt.
This
Sea
rch
War
rant
is is
sued
upo
n in
form
atio
n fu
rnis
hed
unde
r oat
h or
affi
rmat
ion
by th
e pe
rson
(s) s
how
n.
IN T
HE
MA
TTER
OF
AO
C-C
R-1
19, R
ev. 6
/12
Nam
e O
f App
lican
t
Dat
e Is
sued
Tim
e Is
sued
PM
Nam
e O
f Add
ition
al A
ffian
t
I cer
tify
that
this
Sea
rch
War
rant
was
rece
ived
and
exec
uted
as
follo
ws:
Dat
e R
ecei
ved
Dat
e E
xecu
ted
as c
omm
ande
d.
I sei
zed
the
item
s lis
ted
on th
e at
tach
edin
vent
ory .
I did
not
sei
ze a
ny it
ems.
This
War
rant
WA
S N
OT
exec
uted
with
info
rty-e
ight
(48)
hou
rs o
f the
dat
e of
issu
ance
and
I her
eby
retu
rn it
not
exe
cute
d.
AM
PMA
MTi
me
Exe
cute
d
Tim
e R
ecei
ved
PM
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
Incid
ent N
umbe
rD
epar
tmen
t Or A
genc
y O
f Offi
cer
Dep
uty
CS
CM
agis
trate
Nam
e (T
ype
Or P
rint)
Dat
e
Assi
stan
t CS
CD
istri
ct C
t. Ju
dge
CSC
Sup
erio
r Ct.
Judg
e
© 2
012
Adm
inis
trativ
e O
ffice
of t
he C
ourts
Nam
e O
f Add
ition
al A
ffian
t
Nam
e O
f Offi
cer M
akin
g R
etur
n (T
ype
Or P
rint)
Nam
e O
f Cle
rk (T
ype
Or P
rint)
Dat
eTi
me
AM
PM
This
Sea
rch
War
rant
was
retu
rned
to th
e un
ders
igne
d cl
erk
on th
e da
te a
nd ti
me
show
n be
low
.
Dep
CSC
CS
CAs
st C
SC
This
Sea
rch
War
rant
was
del
iver
ed to
me
on th
e da
te a
nd a
t the
tim
e sh
own
belo
w w
hen
the
Offi
ce o
f the
Cle
rk
of S
uper
ior C
ourt
is c
lose
d fo
r the
tran
sact
ion
of b
usin
ess.
By
sign
ing
belo
w, I
cer
tify
that
I w
ill d
eliv
er th
isS
earc
h W
arra
nt to
the
Offi
ce o
f the
Cle
rk o
f Sup
erio
r Cou
rt as
soo
n as
pos
sibl
e on
the
Cle
rk’s
nex
t bus
ines
s da
y.
Dat
eTi
me
AM
PMN
ame
Of M
agis
trate
(Typ
e O
r Prin
t)S
igna
ture
Of M
agis
trate
Sig
natu
re
Sig
natu
re O
f Cle
rk
Forms-Pg 15
bein
g du
ly s
wor
n, re
ques
t tha
t the
Cou
rt is
sue
a w
arra
nt to
sea
rch
the
pers
on,
plac
e, v
ehic
le, a
nd o
ther
item
s de
scrib
ed in
this
app
licat
ion
and
to fi
nd a
nd s
eize
the
prop
erty
and
per
son
desc
ribed
in th
is a
pplic
atio
n. T
here
is p
roba
ble
caus
e to
belie
ve th
at (D
escr
ibe
prop
erty
to b
e se
ized
; or i
f sea
rch
war
rant
is to
be
used
for s
earc
hing
a
plac
e to
ser
ve a
n ar
rest
war
rant
or
othe
r pr
oces
s, n
ame
pers
on to
be
arre
sted
)
inth
efo
llow
ing
prem
ises
(Giv
e ad
dres
s an
d, if
use
ful,
desc
ribe
prem
ises
)
tape
reco
rded
and
I ha
ve fi
led
each
with
the
clre
k.
In a
dditi
on to
the
affid
avit
incl
uded
abo
ve, t
his
appl
icat
ion
is s
uppo
rted
byad
ditio
nal a
ffida
vits
, atta
ched
, mad
e by
(Inse
rt na
me
and
addr
ess;
or i
f law
enf
orce
men
t offi
cer,
nam
e, ra
nk a
nd a
genc
y)
I, (and
)
APP
LIC
ATI
ON
FO
R S
EAR
CH
WA
RR
AN
T
The
appl
ican
t sw
ears
or a
ffirm
s to
the
follo
win
g fa
cts
to e
stab
lish
prob
able
cau
se
for t
he is
suan
ce o
f a s
earc
h w
arra
nt:
Mag
istra
teJu
dge
Dep
. CS
CC
lerk
Of S
uprio
r Cou
rt
eA
sst.
CS
C
Sig
natu
re
SWO
RN
/AFF
IRM
ED A
ND
SU
SCR
IBED
TO
BEF
OR
E M
E
This
test
imon
y ha
s be
en (c
heck
app
ropr
iate
box
)re
duce
d to
writ
ing
Dat
e
onth
efo
llow
ing
pers
on(s
) (G
ive
nam
e(s)
and
, if u
sefu
l, de
scrib
e pe
rson
(s))
(and
) inth
efo
llow
ing
vehi
cle(
s) (D
escr
ibe
vehi
cle(
s))
AO
C-C
R-1
19, R
ev. 6
/12
cons
titut
es e
vide
nce
of a
crim
e an
d th
e id
entit
y of
a p
erso
n pa
rtici
patin
g in
acr
ime,
(Nam
e cr
ime)
and
is lo
cate
d (C
heck
app
ropr
iate
box
(es)
and
fill-
in s
peci
fied
info
rmat
ion)
,,(a
nd) (N
ame
and/
or d
escr
ibe
othe
r pla
ces
or it
ems
to b
e se
arch
ed, i
f app
licab
le)
In a
dditi
on to
the
affid
avit
incl
uded
abo
ve, t
his
appl
icat
ion
is s
uppo
rted
bysw
orn
test
imon
y, g
iven
by
NO
TE:
If m
ore
spac
e is
nee
ded
for a
ny s
ectio
n, c
ontin
ue th
e st
atem
ent o
n an
atta
ched
shee
t of p
aper
with
a n
otat
ion
sayi
ng “s
ee a
ttach
men
t.” D
ate
the
cont
inua
tion
and
incl
ude
on it
the
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ffice
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ourts
.
Nam
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f App
lican
t (Ty
pe O
r Prin
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Date
Sig
natu
re O
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lican
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Forms-Pg 16
[Check in all domestic violence and stalking cases covered by G.S. 15A-534.1(b)] produce him/her at the first session of District or Superior Court held in this county after the entry of this Order or, if no session is held before (enter date and time 48 hours after time of arrest) ,
AM PM produce him/her before a magistrate of this county at that time to determine conditions of pretrial release.
CUSTODY RELEASEHOUSE ARREST with ELECTRONIC MONITORING administered by (agency) and the SECURED
You may leave your residence for the purpose(s) of employment counseling course of study vocational training
Your release is not authorized. The defendant is required to provide (check all that apply) fingerprints under G.S. 15A-502(a1) or (a2). a DNA sample under G.S. 15A-266.3A.Prior to release, the defendant shall provide his/her (check all that apply) fingerprints. DNA sample.The defendant has been (i) charged with a felony while on probation (complete AOC-CR-272, Side One). (ii) arrested for violation of probation with a pending felony charge or prior con viction requiring registration under G.S. 14, Article 27A (complete AOC-CR-272, Side Two).
This was the defendant's second or subsequent failure to appear in this case.
STATE OF NORTH CAROLINAFile No.
Time
Magistrate Deputy CSC Assistant CSCClerk Of Superior Court District Court Judge Superior Court Judge
Date
Your release is subject to the conditions as shown on the attached AOC-CR-270. Other: .
The defendant was arrested or surrendered after failing to appear as required under a prior release order.
PMAM
STATE VERSUSName And Address Of Defendant
District Superior AM PMTimeDate
Your release is authorized upon execution of your:
Signature Of Judicial Official
Amount Of Bond
$
CONDITIONS OF RELEASEAND RELEASE ORDER
Location Of Court
Date
Superior Court DivisionDistrictIn The General Court Of Justice
Offenses And Additional File Numbers
SECURED BOND in the amount shown above
To The Defendant Named Above, you are ORDERED to appear before the Court as provided above and at all subsequent continued dates. If you fail to appear, you will be arrested and you may be charged with the crime of willful failure to appear.
The defendant has been advised of charge(s) against him/her and his/her right to communicate with counsel and friends.
Additional Information
To The Custodian Of The Detention Facility Named Below, you are ORDERED to receive in your custody the defendant named above who may be released if authorized above. If the defendant is not sooner released, you are ORDERED to: produce him/her in Court as provided above. hold him/her as provided on the attached AOC-CR-272. for the following purpose: .
ORDER OF COMMITMENT
Signature Of Person Agreeing To Supervise Defendant
Signature Of Jailer
County
G.S. Chapter 15A, Art. 25, 26
AOC-CR-200, Rev. 12/12© 2012 Administrative Office of the Courts
Signature Of Judicial Official
WRITTEN PROMISE TO APPEAR OR CUSTODY RELEASEI, the undersigned, promise to appear at all hearings, trials or otherwise as the Court may require and to abide by any restrictions set out above. I understand and agree that this promise is effective until the entry of judgment in the District Court from which no appeal is taken or until the entry of judgment in Superior Court. If I am released to the custody of another person, I agree to be placed in that person's custody, and that person agrees by his/her signature to supervise me.
Name Of Person Agreeing To Supervise Defendant (Type Or Print)
Name Of Detention Facility
Date
Address Of Person Agreeing To Supervise Defendant
DEFENDANT RELEASED ON BAILDate
Signature Of Defendant
#
SeeAttachment
You also may bearrested without a warrant if you violate any condition of release in this Order or in any document incorporated by reference.
WRITTEN PROMISE to appear UNSECURED BOND in the amount shown above
BOND above.
This Order is entered upon defendant’s warrantless arrest for violation of conditions of release entered previously for the above-captioned case in the Order dated .
Forms-Pg 17
© 2012 Administrative Office of the Courts
SUPPLEMENTAL ORDERS FOR COMMITMENT
TimeDate Signature Of Judicial OfficialPlace Purpose
DEFENDANT RECEIVED BY DETENTION FACILITYTimeDate Signature Of Jailer
DEFENDANT RELEASED FOR COURT APPEARANCETimeDate Signature Of Jailer
NOTE TO CUSTODIAN: This form shall accompany the defendant to court for all appearances.
The defendant is next Ordered produced in Court as follows:
CONDITIONS OF RELEASE MODIFICATIONSThe Conditions of Release on the reverse are modified as follows:
Modification Date Signature Of Judicial Official
AOC-CR-200, Side Two, Rev. 12/12 Forms-Pg 18
[Check in all domestic violence and stalking cases covered by G.S. 15A-534.1(b)] produce him/her at the first session of District or Superior Court held in this county after the entry of this Order or, if no session is held before (enter date and time 48 hours after time of arrest) ,
AM PM produce him/her before a magistrate of this county at that time to determine conditions of pretrial release.
CUSTODY RELEASEHOUSE ARREST with ELECTRONIC MONITORING administered by (agency) and the SECURED
You may leave your residence for the purpose(s) of employment counseling course of study vocational training
Your release is not authorized. The defendant is required to provide (check all that apply) fingerprints under G.S. 15A-502(a1) or (a2). a DNA sample under G.S. 15A-266.3A.Prior to release, the defendant shall provide his/her (check all that apply) fingerprints. DNA sample.The defendant has been (i) charged with a felony while on probation (complete AOC-CR-272, Side One). (ii) arrested for violation of probation with a pending felony charge or prior con viction requiring registration under G.S. 14, Article 27A (complete AOC-CR-272, Side Two).
This was the defendant's second or subsequent failure to appear in this case.
STATE OF NORTH CAROLINAFile No.
Time
Magistrate Deputy CSC Assistant CSCClerk Of Superior Court District Court Judge Superior Court Judge
Date
Your release is subject to the conditions as shown on the attached AOC-CR-270. Other: .
The defendant was arrested or surrendered after failing to appear as required under a prior release order.
PMAM
STATE VERSUSName And Address Of Defendant
District Superior AM PMTimeDate
Your release is authorized upon execution of your:
Signature Of Judicial Official
Amount Of Bond
$
CONDITIONS OF RELEASEAND RELEASE ORDER
Location Of Court
Date
Superior Court DivisionDistrictIn The General Court Of Justice
Offenses And Additional File Numbers
SECURED BOND in the amount shown above
To The Defendant Named Above, you are ORDERED to appear before the Court as provided above and at all subsequent continued dates. If you fail to appear, you will be arrested and you may be charged with the crime of willful failure to appear.
The defendant has been advised of charge(s) against him/her and his/her right to communicate with counsel and friends.
Additional Information
To The Custodian Of The Detention Facility Named Below, you are ORDERED to receive in your custody the defendant named above who may be released if authorized above. If the defendant is not sooner released, you are ORDERED to: produce him/her in Court as provided above. hold him/her as provided on the attached AOC-CR-272. for the following purpose: .
ORDER OF COMMITMENT
Signature Of Person Agreeing To Supervise Defendant
Signature Of Jailer
County
G.S. Chapter 15A, Art. 25, 26
AOC-CR-200, Rev. 12/12© 2012 Administrative Office of the Courts
Signature Of Judicial Official
WRITTEN PROMISE TO APPEAR OR CUSTODY RELEASEI, the undersigned, promise to appear at all hearings, trials or otherwise as the Court may require and to abide by any restrictions set out above. I understand and agree that this promise is effective until the entry of judgment in the District Court from which no appeal is taken or until the entry of judgment in Superior Court. If I am released to the custody of another person, I agree to be placed in that person's custody, and that person agrees by his/her signature to supervise me.
Name Of Person Agreeing To Supervise Defendant (Type Or Print)
Name Of Detention Facility
Date
Address Of Person Agreeing To Supervise Defendant
DEFENDANT RELEASED ON BAILDate
Signature Of Defendant
#
SeeAttachment
You also may bearrested without a warrant if you violate any condition of release in this Order or in any document incorporated by reference.
WRITTEN PROMISE to appear UNSECURED BOND in the amount shown above
BOND above.
This Order is entered upon defendant’s warrantless arrest for violation of conditions of release entered previously for the above-captioned case in the Order dated .
Forms-Pg 19
© 2012 Administrative Office of the Courts
SUPPLEMENTAL ORDERS FOR COMMITMENT
TimeDate Signature Of Judicial OfficialPlace Purpose
DEFENDANT RECEIVED BY DETENTION FACILITYTimeDate Signature Of Jailer
DEFENDANT RELEASED FOR COURT APPEARANCETimeDate Signature Of Jailer
NOTE TO CUSTODIAN: This form shall accompany the defendant to court for all appearances.
The defendant is next Ordered produced in Court as follows:
CONDITIONS OF RELEASE MODIFICATIONSThe Conditions of Release on the reverse are modified as follows:
Modification Date Signature Of Judicial Official
AOC-CR-200, Side Two, Rev. 12/12 Forms-Pg 20
STATE OF NORTH CAROLINA
Magistrate Deputy CSC Assistant CSC Clerk Of Superior CourtCustodian Of Detention Facility [G.S. 15A-537(c)]
Magistrate Deputy CSC Assistant CSC Clerk Of Superior CourtCustodian Of Detention Facility [G.S. 15A-537(c)]
Defendant's Property Appearance Bond - I, the undersigned defendant, acknowledge that I am bound to pay the State of North Carolina the sumshown above, subject to the conditions of this Bond stated on the reverse side, and as security for said Bond have executed a mortgage or deed of trust to real or personal property, payable to the State of North Carolina and with power of sale conditioned upon the breach of any condition of this Bond.
Signature Of Official Accepting Cash
PROFESSIONAL BONDSMANName Of Runner, If Applicable
License No. Of Runner
INSURANCE COMPANYName Of Insurance Company
Power Of Appointment No. Of Bail Agent
Name Of Bail Agent
Signature Of SuretySIGNATURE
Signature Of Surety
License No. Of Bail Agent
ACCOMMODATION BONDSMAN
Name And Address Of Accommodation Bondsman
Telephone No. Telephone No.Social Security No.
See Page Two for additional accommodation bondsman executing this bond.
Signature Of Defendant Date Of Execution Of Bond
Name And Address Of Accommodation Bondsman
Social Security No.
COMPLETE IF CASH DEPOSITED
Name Of Bondsman
License No. Of Bondsman
Name Of Official Accepting Cash (Type Or Print) Receipt No.
NOTE: If cash deposited, see note on reverse side.
SignatureSWORN AND SUBSCRIBED TO BEFORE ME SWORN AND SUBSCRIBED TO BEFORE ME
DateSignatureDate
See Attachment
APPEARANCE BONDFOR
PRETRIAL RELEASESocial Security No. Telephone No. Of Defendant
$Total Bond Required Amount Of This Bond
$
Unsecured Appearance Bond - I, the undersigned defendant, acknowledge that my personal representatives and I are bound to pay the State of North Carolina the sum shown above, subject to the conditions of this Bond stated on the reverse side.Cash Appearance Bond (See note on reverse side.) - I, the undersigned defendant, acknowledge that I am bound to pay the State of North Carolina the sum shown above, and hereby deposit the cash identified below as security with the understanding that the deposit will be returned upon the Court's determination that the conditions of release have been performed, subject to the conditions of this Bond stated on the reverse side, and that it will be available to satisfy my obligations.
Surety Appearance Bond - We, the undersigned, jointly and severally acknowledge that we and our personal representatives are bound to pay the State of North Carolina the sum shown above, subject to the conditions of this Bond stated on the reverse side.
(Professional bondsman, Bail Agent and Runners) - The "Affidavit" on the reverse side of this Bond is complete and true.Cash Deposited By Surety (See note on reverse side.) - We have deposited the cash identified below to secure our obligations as sureties on this bond with the understanding that the deposit will be returned to us upon the Court's determination that the conditions of pretrial release have been performed, and that it will NOT be available to satisfy defendant's obligations.
Original-File (Over)AOC-CR-201, Rev. 3/09
© 2009 Administrative Office of the Courts(see CR-238 if release afterjudgment in superior court)
In The General Court Of JusticeDistrict Superior Court DivisionCounty
G.S. 15A-531, 15A-534, 15A-544.2
Name And Mailing Address Of Defendant
Offenses And Additional File Numbers#
File No.
Each accommodation bondsman, by signing on the reverse or on Page Two, states: "I have reached the age of 18 years and am a bona fide resident of North Carolina. Aside from love and affection and release of the above named defendant, I have received no consideration for acting as surety. I own sufficient property over and above all liabilities, homestead and other exemptions allowed me by law to enable me to pay this Bond should it be ordered forfeited. I understand that if I sign this Bond without sufficient property, I am guilty of a crime."
AFFIX STAMP OR POWER OF ATTORNEY
HERE
AFFIDAVIT
1.2.3.4.
CONDITIONSThe conditions of this Bond are that the above named defendant shall appear in the above entitled action(s) whenever required and will at all times remain amenable to the orders and processes of the Court. It is agreed and understood that this Bond is effective and binding upon the defendant and each surety throughout all stages of the proceedings in the trial divisions of the General Court of Justice until the entry of judgment in the district court from which no appeal is taken or until the entry of judgment in the superior court. If the defendant appears as ordered and otherwise performs the foregoing conditions of the bond, then the bond is to be void, but if the defendant fails to obey any of these conditions, the Court will forfeit the bond pursuant to Part 2 of Article 26 of Chapter 15A of the General Statutes.
I have not, nor has anyone for my use, been promised or received any collateral, security or premium for executing this Bond.I have been promised a premium in the amount shown below, which is due on the date shown below.I have received a premium in the amount shown below.I have been given collateral security by the person named below, of the nature and in the amount shown below.
$ $
"Professional bondsmen, surety bondsmen [bail agent], and runners must file with the clerk of court having jurisdiction over the principal, an affidavit on a form furnished by the Administrative Office of the Courts." G.S. 58-71-140(d). Check all options that apply.
Name Of Person From Whom Collateral Received Nature Of Collateral Value
Amount Of Premium Received
AOC-CR-201, Side Two, Rev. 3/09© 2009 Administrative Office of the Courts
NOTE:
To Official Taking The Bond. Use this form for all cash bonds. Only magistrate or clerk may take cash bond. Jailer may not take cash bond. Complete this form as follows:
NOTES ON CASH BONDS:(1)
RETURN OF CUSTODIAN OF DETENTION FACILITYThe defendant named on the reverse was released from my custody on the date shown below upon the execution of this Appearance Bond.
Date Defendant Released Signature Of CustodianOtherDeputy SheriffSheriff
When Cash Deposited By Defendant Or By Another Person Who Intends For The Cash To Be Used To Satisfy The Defendant's Obligations. Enter defendant's name, address and SS# at the top of Side One. Check "Cash Appearance Bond." Have defendant sign. Do no more. No other person's name should appear on this form. Enter your name, sign and enter receipt number under "Complete If Cash Deposited." Make receipt out to DEFENDANT, not to any other person. When Cash Deposited By Another Person Who Does NOT Intend For The Cash To Be Used To Satisfy The Defendant's Obligations. Enter defendant's name, address and SS# at the top of Side One. Check "Surety Appearance Bond." Also check "Cash Deposited By Surety." Have defendant sign. Enter name, address and SS# of person depositing cash under "Accommodation Bondsman." Have that person sign under "Signature of Surety." Complete notarization for that person. Enter your name, sign and enter receipt number under "Complete If Cash Deposited." Make receipt out to person depositing the cash.
(2) To Bookkeeper. When case disposed, disburse cash as follows: (1) If "Cash Appearance Bond" checked on Side One, disburse to Defendant or applyto defendant's obligations if court so orders. (2) If "Surety Appearance Bond" and "Cash Deposited by Surety" are checked on Side One, disburse only to person named under "Accommodation Bondsman."
(3) Bond With Insurance Company As Surety Same As Cash Except In Child Support. G.S. 15A-531(4) provides that an appearance bond executed by a bail agent acting on behalf of an insurance company is the same as a cash bond, except in child support contempt proceedings where only cash may satisfy a cash bond requirement.
Amount Of Premium Promised Date Due
SIGNATURE
Assistant CSC Clerk of Superior Court
Name And Address Of Accommodation Bondsman
AOC-CR-201A, Rev. 9/03 2003 Administrative Office of the Courts
STATE VERSUSFile No.
Name Of Defendant
ADDITIONAL ACCOMMODATION BONDSMAN
Signature Of SuretySIGNATURE
Signature Of Surety
Telephone No. Telephone No.
Magistrate
SWORN AND SUBSCRIBED TO BEFORE ME SWORN AND SUBSCRIBED TO BEFORE ME
Deputy CSC Assistant CSC Clerk of Superior CourtCustodian Of Detention Facility [G.S. 15A-537(c)]
Magistrate Deputy CSCCustodian Of Detention Facility [G.S. 15A-537(c)]
SignatureSignatureDate
Social Security No.
Signature Of Surety
ADDITIONAL ACCOMMODATION BONDSMANName And Address Of Accommodation Bondsman
Social Security No.
Signature Of SuretySIGNATURE
Telephone No.Telephone No.
SWORN AND SUBSCRIBED TO BEFORE ME
Magistrate Deputy CSC Assistant CSC Clerk of Superior CourtCustodian Of Detention Facility [G.S. 15A-537(c)]
SignatureDateSWORN AND SUBSCRIBED TO BEFORE ME
Magistrate Deputy CSC Assistant CSC Clerk of Superior CourtCustodian Of Detention Facility [G.S. 15A-537(c)]
Signature
ADDITIONAL ACCOMMODATION BONDSMANName And Address Of Accommodation Bondsman Name And Address Of Accommodation Bondsman
Name And Address Of Accommodation Bondsman
Name And Address Of Accommodation Bondsman
Social Security No.
Date
Date
Social Security No.
Signature Of Surety Signature Of Surety
Telephone No. Telephone No.
Magistrate
SignatureSWORN AND SUBSCRIBED TO BEFORE ME SWORN AND SUBSCRIBED TO BEFORE ME
Signature
Deputy CSC Assistant CSC Clerk of Superior CourtCustodian Of Detention Facility [G.S. 15A-537(c)]
Magistrate Deputy CSC Assistant CSC Clerk of Superior CourtCustodian Of Detention Facility [G.S. 15A-537(c)]
Social Security No.
Date
Social Security No.
Date
Forms-Pg 24
(b) The surrender of the defendant has occurred before an Order of Forfeiture was entered for the appearance bond for the offense(s) listed above.
is to appear on these charges. was bonded on these charges. Other: .
is to appear on these charges. was bonded on these charges.
County Where Defendant To Appear If Different
Name Of Defendant
STATE OF NORTH CAROLINA
I, the undersigned custodian, acknowledge that the defendant is in custody as indicated.
RECEIPT OR ACKNOWLEDGMENT OF CUSTODIAN
I understand that this Surrender does not relieve me from my responsibility if an Order of Forfeiture has been entered before this Surrender. I also understand that I must apply to the Court for relief in that matter.
Date Signature Of SuretyName Of Surety (Type Or Print)
(See NOTES TO MAGISTRATE on reverse)Original-Clerk Copy-Surety Copy-Custodian
Date
NOTES TO CUSTODIAN:(1)
Signature Of Custodian/JailerName Of Custodian/Jailer (Type Or Print)
(2) G.S. 15A-540(b) requires that a defendant surrendered by a surety must have an immediate hearing on whether the defendant is again entitled to release and, if so, upon what conditions. Take the defendant, with this form, to a judicial official for this hearing. When the above Receipt is completed, provide surety with a copy of this form.
Only an actual surety may surrender the defendant. If the person offering the defendant for surrender presents an appearance bond form (AOC-CR-201) with the box checked for a "Cash Appearance Bond," then the person is not the surety for the defendant's appearance. Do not accept the surrender of the defendant. If the boxes for "Surety Appearance Bond" and "Cash Deposited By Surety" are checked, and the person attempting to surrender the defendant is the same person who signed the bond as surety, then that person is the surety and you may accept the surrender.
File No.
Superior Court Division
II.
(You must complete both I. and II. below.)
Status Of Order Of Forfeiture (check only one) The surrender of the defendant has occurred after an Order of Forfeiture was entered for the appearance bond for the offense(s) listed above, and after an order for arrest was issued.
(a)
I arrested the defendant and now surrender the defendant to the jail in this county where the defendant(a)
STATE VERSUS
County
SURRENDER OF DEFENDANT BY SURETY
G.S. 15A-540, -534
$
I, the undersigned surety for the named defendant, request that the Court release me from the defendant's Appearance Bond which I signed as indicated above. A certified copy of the bail bond is attached.
Name Of Surety(ies)
Date Of Appearance Bond Amount Of Bond
I. Form Of Surrender (check only one)
(b) I surrender the defendant who is currently in the jail in this county where the defendant
All File Nos. And Offenses
In The General Court Of JusticeDistrict
AOC-CR-214, Rev. 6/08© 2008 Administrative Office of the Courts
If an order for arrest was issued for the defendant's failure to appear, the court date in the new release order should bethe same as the court date, if any, in the order for arrest. The order for arrest should be served on the defendant, if possible, without detaining the defendant beyond the time when he or she should be released under the new release order. If the order for arrest cannot be served in that time, use the court's records to learn the court date in the order for arrest, and arrange to have order for arrest recalled.
If the defendant was surrendered before a breach of the conditions of release, the original conditions of release should be reentered. The defendant remains in custody until conditions of original release order are again satisfied. The court date remains the same.
(1)
(2)
(3)
(4)
If the defendant was surrendered after a breach of the conditions of release, G.S. 15A-540(c) requires that a judicial official determine whether the defendant is again entitled to pretrial release and, if so, upon what conditions. If the breach was a failure to appear for any charge(s) covered by the appearance bond provided at the time of surrender, G.S. 15A-534(d1) provides that the official shall at a minimum impose the conditions of release recommended in an order for arrest issued for that failure to appear. If no conditions were recommended, the judicial official shall require a secured bond at least double the amount of the most recent secured or unsecured bond, or at least $500 if there was no monetary bond previously required. On the new release order, check the appropriate box(es) indicating the failure to appear.
If the defendant was surrendered in a county other than the county where the defendant is to appear, return original order for arrest, if any, with return of service completed, along with this form and a copy of the new release order, to the county where the defendant is to appear. When conditions of pretrial release are satisfied, return original of the new release order with any custodian's entries completed, together with the original appearance bond, if any, to the county where the defendant is to appear.
NOTES TO MAGISTRATE:
AOC-CR-214, Side Two, Rev. 6/08© 2008 Administrative Office of the Courts
Driv
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Lice
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7.6.5.3. 4.1.FT
A - R
ELEA
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RD
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.S. 1
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as b
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and
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2.FT
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INAL
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MM
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R C
ITAT
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(Do
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se fo
r inf
ract
ion.
) [G
.S. 1
5A-3
05(b
)(3)
]th
e de
fend
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as fa
iled
on th
e da
te s
how
n to
app
ear a
s re
quire
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a d
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dete
rmin
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s of
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ase,
and
for c
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he d
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is u
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com
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t aut
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To a
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aut
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ser
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n O
rder
For
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The
Cou
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TRU
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F IN
DIC
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.S. 1
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a co
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.[N
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To A
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ting
Offi
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If t
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optio
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che
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, def
enda
nt m
ust b
e fin
gerp
rinte
d. G
.S. 1
5A-5
02(a
).]
FTA
- SH
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CAU
SE A
FTER
FTC
[G.S
. 15A
-305
(b)(
8)]
the
defe
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IMIN
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UD
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ENT
[G.S
. 15A
-305
(b)(
8); -
1362
(c);
-136
4(a)
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fend
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as fa
iled
by th
e da
te s
how
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pay
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iled,
as
requ
ired
upon
suc
h fa
ilure
, to
appe
ar o
n th
at d
ate
and
show
ca
use
why
the
defe
ndan
t sho
uld
not b
e im
pris
oned
.PR
OBA
BLE
CAU
SE T
HAT
DEF
END
ANT
MAY
FAI
L TO
APP
EAR
- C
RIM
INAL
CO
NTE
MPT
[G.S
. 15A
-305
(b)(
9); 5
A-16
]th
is C
ourt
has
initi
ated
ple
nary
pro
ceed
ings
for c
onte
mpt
aga
inst
the
defe
ndan
t und
er
G.S
. 5A-
16, h
as is
sued
a s
how
cau
se o
rder
and
find
s pr
obab
le c
ause
to b
elie
ve th
at th
e de
fend
ant w
ill no
t app
ear a
s re
quire
d in
resp
onse
to th
at o
rder
.PR
OBA
TIO
N V
IOLA
TIO
N [
G.S
. 15A
-305
(b)(
4); -
1345
(a)]
the
prob
atio
n of
ficer
has
pro
vide
d th
e co
urt w
ith a
writ
ten
stat
emen
t, si
gned
by
the
prob
atio
n of
ficer
, al
legi
ng th
at th
e de
fend
ant h
as v
iola
ted
spec
ified
con
ditio
ns o
f the
def
enda
nt's
pro
batio
n an
d a
copy
of
the
writ
ten
stat
emen
t is
atta
ched
. 8.
Cou
nty
In T
he G
ener
al C
ourt
Of J
ustic
eD
istri
ctSu
perio
r Cou
rt D
ivis
ion
Offe
nse
OR
DER
FO
R A
RR
EST
Law
Enf
orce
men
t Cas
e N
o.LI
D N
o.S
ID N
o.FB
I No.
Sig
natu
reC
ourt
Dat
e
PM
AM
Loca
tion
Of C
ourt
Dep
uty
CS
CC
lerk
Of S
uper
ior C
ourt
Mag
istra
te
Ass
t. C
SC
#
DC
Jud
geS
C J
udge
(Ove
r)A
OC
-CR
-217
, Rev
. 4/1
1©
201
1 A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
Nam
e O
f Offi
cer (
Type
Or P
rint)
Nam
e O
f Offi
cer (
Type
Or P
rint)
AOC
-CR
-217
, Sid
e Tw
o, R
ev. 4
/11,
© 2
011
Adm
inis
trativ
e O
ffice
of t
he C
ourts
Dat
e W
aive
d
APP
EAL
ENTR
IES
RED
ELIV
ERY/
REI
SSU
AN
CE
The
defe
ndan
t, in
ope
n co
urt,
give
s no
tice
of a
ppea
l to
the
Sup
erio
r Cou
rt.Th
e cu
rrent
pre
trial
rele
ase
orde
r is
mod
ified
as
follo
ws:
Dep
. CS
CA
sst.
CS
CC
SC
I cer
tify
that
this
Ord
er w
as re
ceiv
ed a
nd s
erve
d as
follo
ws:
WA
IVER
OF
PRO
BA
BLE
CA
USE
HEA
RIN
G
RET
UR
N F
OLL
OW
ING
RED
ELIV
ERY/
REI
SSU
AN
CE
RET
UR
N O
F SE
RVI
CE
If th
is O
rder
For
Arr
est i
s no
t ser
ved
with
in o
ne h
undr
ed a
nd e
ight
y (1
80)
days
, it m
ust b
e re
turn
ed to
the
Cle
rk o
f Cou
rt in
the
coun
ty in
whi
ch it
was
issu
ed w
ith th
e re
ason
for t
he fa
ilure
of s
ervi
ce n
oted
ther
eon.
The
offi
cer
mus
t sta
te a
ll st
eps
take
n by
his
/her
dep
artm
ent i
n at
tem
ptin
g to
ser
ve th
eor
der a
nd a
ny in
form
atio
n ob
tain
ed a
bout
the
whe
reab
outs
of t
he
defe
ndan
t.
B
y ar
rest
ing
the
defe
ndan
t and
brin
ging
the
defe
ndan
t bef
ore:
Dat
e R
ecei
ved
Dat
e R
ecei
ved
I cer
tify
that
this
Ord
er w
as re
ceiv
ed a
nd s
erve
d as
follo
ws:
Sig
natu
re
T
his
Ord
er W
AS
NO
T se
rved
for t
he fo
llow
ing
reas
on:
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
Sig
natu
re O
f Dis
trict
Cou
rt Ju
dge
The
unde
rsig
ned
defe
ndan
t, w
ith th
e co
nsen
t of h
is/h
er a
ttorn
ey, w
aive
s th
e rig
ht to
a p
roba
ble
caus
e he
arin
g.S
igna
ture
Of D
efen
dant
Sig
natu
re O
f Atto
rney
B
y ar
rest
ing
the
defe
ndan
t and
brin
ging
the
defe
ndan
t bef
ore:
T
his
Ord
er W
AS
NO
T se
rved
for t
he fo
llow
ing
reas
on:
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
Nam
e O
f Jud
icia
l Offi
cial
Dat
e
Nam
e O
f Jud
icia
l Offi
cial
Dat
e
Dep
artm
ent O
r Age
ncy
Of O
ffice
r
Dep
artm
ent O
r Age
ncy
Of O
ffice
r
AM PM
Tim
e S
erve
dD
ate
Ser
ved
Dat
e R
etur
ned
Dat
e S
erve
dD
ate
Ret
urne
dAM PM
Tim
e S
erve
d
Driv
ers
Lice
nse
No.
& S
tate
Type
Of B
ond
Offe
nse
In V
iola
tion
Of G
.S.
Dat
e O
f Offe
nse
File
No.
See
Atta
chm
ent
Cou
rt Ti
me
You
are
DIR
ECTE
D to
take
the
defe
ndan
t int
o cu
stod
y an
d br
ing
the
defe
ndan
t bef
ore
a ju
dici
al o
ffici
al fo
r the
purp
ose
of:
Nam
e, A
ddre
ss &
Tel
epho
ne N
o. O
f Def
enda
nt
Rac
e
THE
STA
TE O
F N
OR
TH C
AR
OLI
NA
VS.
Soc
ial S
ecur
ity N
o.
Nam
e A
nd A
ddre
ss O
f Def
enda
nt's
Em
ploy
er
Dat
e D
efen
dant
Fai
led
To A
ppea
r
Am
ount
Of B
ond
$
TRU
E B
ILL
OF
IND
ICTM
ENT
ON
LYD
ate
Of A
rres
t & C
heck
Dig
it N
o. (A
s S
how
n O
n Fi
nger
prin
t Car
d)
Offe
nse
Cod
e
Dat
e Is
sued
Sex
Dat
e O
f Birt
hA
ge
STA
TE O
F N
OR
TH C
AR
OLI
NA
Oth
er: (
spec
ify)
7.6.5.3. 4.1.FT
A - R
ELEA
SE O
RD
ER [G
.S. 1
5A-3
05(b
)(2)
]th
e de
fend
ant h
as b
een
arre
sted
and
rele
ased
from
cus
tody
and
has
faile
d on
the
date
sho
wn
to a
ppea
ras
requ
ired
by th
e R
elea
se O
rder
.
T
his
is th
e de
fend
ant's
sec
ond
or s
ubse
quen
t fai
lure
to a
ppea
r on
thes
e ch
arge
s.
2.FT
A - C
RIM
INAL
SU
MM
ON
S O
R C
ITAT
ION
(Do
not u
se fo
r inf
ract
ion.
) [G
.S. 1
5A-3
05(b
)(3)
]th
e de
fend
ant h
as fa
iled
on th
e da
te s
how
n to
app
ear a
s re
quire
d by
a d
uly
exec
uted
Crim
inal
Su
mm
ons
or b
y a
Cita
tion
that
cha
rged
the
defe
ndan
t with
a m
isde
mea
nor.
dete
rmin
ing
cond
ition
s of
rele
ase,
and
for c
omm
itmen
t if t
he d
efen
dant
is u
nabl
e to
com
ply.
com
mitm
ent s
ince
rele
ase
of th
e de
fend
ant i
s no
t aut
horiz
ed.
To a
ny o
ffice
r with
aut
horit
y an
d ju
risdi
ctio
n to
ser
ve a
n O
rder
For
Arr
est:
The
Cou
rt fin
ds th
at:
TRU
E BI
LL O
F IN
DIC
TMEN
T [G
.S. 1
5A-3
05(b
)(1)
]a
Gra
nd J
ury
has
retu
rned
a tr
ue b
ill of
indi
ctm
ent a
gain
st th
e de
fend
ant,
a co
py o
f whi
ch is
atta
ched
.[N
ote
To A
rres
ting
Offi
cer:
If t
his
optio
n is
che
cked
, def
enda
nt m
ust b
e fin
gerp
rinte
d. G
.S. 1
5A-5
02(a
).]
FTA
- SH
OW
CAU
SE A
FTER
FTC
[G.S
. 15A
-305
(b)(
8)]
the
defe
ndan
t has
faile
d on
the
date
sho
wn
to a
ppea
r as
requ
ired
in a
Sho
w C
ause
Ord
er e
nter
ed in
th
is c
rimin
al p
roce
edin
g.FT
A - S
HO
W C
AUSE
OR
DER
IN O
RIG
INAL
CR
IMIN
AL J
UD
GM
ENT
[G.S
. 15A
-305
(b)(
8); -
1362
(c);
-136
4(a)
]th
e de
fend
ant h
as fa
iled
by th
e da
te s
how
n to
pay
a fi
ne o
r cos
ts o
r bot
h as
requ
ired
by a
judg
men
t en
tere
d in
this
cas
e an
d ha
s al
so fa
iled,
as
requ
ired
upon
suc
h fa
ilure
, to
appe
ar o
n th
at d
ate
and
show
ca
use
why
the
defe
ndan
t sho
uld
not b
e im
pris
oned
.PR
OBA
BLE
CAU
SE T
HAT
DEF
END
ANT
MAY
FAI
L TO
APP
EAR
- C
RIM
INAL
CO
NTE
MPT
[G.S
. 15A
-305
(b)(
9); 5
A-16
]th
is C
ourt
has
initi
ated
ple
nary
pro
ceed
ings
for c
onte
mpt
aga
inst
the
defe
ndan
t und
er
G.S
. 5A-
16, h
as is
sued
a s
how
cau
se o
rder
and
find
s pr
obab
le c
ause
to b
elie
ve th
at th
e de
fend
ant w
ill no
t app
ear a
s re
quire
d in
resp
onse
to th
at o
rder
.PR
OBA
TIO
N V
IOLA
TIO
N [
G.S
. 15A
-305
(b)(
4); -
1345
(a)]
the
prob
atio
n of
ficer
has
pro
vide
d th
e co
urt w
ith a
writ
ten
stat
emen
t, si
gned
by
the
prob
atio
n of
ficer
, al
legi
ng th
at th
e de
fend
ant h
as v
iola
ted
spec
ified
con
ditio
ns o
f the
def
enda
nt's
pro
batio
n an
d a
copy
of
the
writ
ten
stat
emen
t is
atta
ched
. 8.
Cou
nty
In T
he G
ener
al C
ourt
Of J
ustic
eD
istri
ctSu
perio
r Cou
rt D
ivis
ion
Offe
nse
OR
DER
FO
R A
RR
EST
Law
Enf
orce
men
t Cas
e N
o.LI
D N
o.S
ID N
o.FB
I No.
Sig
natu
reC
ourt
Dat
e
PM
AM
Loca
tion
Of C
ourt
Dep
uty
CS
CC
lerk
Of S
uper
ior C
ourt
Mag
istra
te
Ass
t. C
SC
#
DC
Jud
geS
C J
udge
(Ove
r)A
OC
-CR
-217
, Rev
. 4/1
1©
201
1 A
dmin
istra
tive
Offi
ce o
f the
Cou
rts
Nam
e O
f Offi
cer (
Type
Or P
rint)
Nam
e O
f Offi
cer (
Type
Or P
rint)
AOC
-CR
-217
, Sid
e Tw
o, R
ev. 4
/11,
© 2
011
Adm
inis
trativ
e O
ffice
of t
he C
ourts
Dat
e W
aive
d
APP
EAL
ENTR
IES
RED
ELIV
ERY/
REI
SSU
AN
CE
The
defe
ndan
t, in
ope
n co
urt,
give
s no
tice
of a
ppea
l to
the
Sup
erio
r Cou
rt.Th
e cu
rrent
pre
trial
rele
ase
orde
r is
mod
ified
as
follo
ws:
Dep
. CS
CA
sst.
CS
CC
SC
I cer
tify
that
this
Ord
er w
as re
ceiv
ed a
nd s
erve
d as
follo
ws:
WA
IVER
OF
PRO
BA
BLE
CA
USE
HEA
RIN
G
RET
UR
N F
OLL
OW
ING
RED
ELIV
ERY/
REI
SSU
AN
CE
RET
UR
N O
F SE
RVI
CE
If th
is O
rder
For
Arr
est i
s no
t ser
ved
with
in o
ne h
undr
ed a
nd e
ight
y (1
80)
days
, it m
ust b
e re
turn
ed to
the
Cle
rk o
f Cou
rt in
the
coun
ty in
whi
ch it
was
issu
ed w
ith th
e re
ason
for t
he fa
ilure
of s
ervi
ce n
oted
ther
eon.
The
offi
cer
mus
t sta
te a
ll st
eps
take
n by
his
/her
dep
artm
ent i
n at
tem
ptin
g to
ser
ve th
eor
der a
nd a
ny in
form
atio
n ob
tain
ed a
bout
the
whe
reab
outs
of t
he
defe
ndan
t.
B
y ar
rest
ing
the
defe
ndan
t and
brin
ging
the
defe
ndan
t bef
ore:
Dat
e R
ecei
ved
Dat
e R
ecei
ved
I cer
tify
that
this
Ord
er w
as re
ceiv
ed a
nd s
erve
d as
follo
ws:
Sig
natu
re
T
his
Ord
er W
AS
NO
T se
rved
for t
he fo
llow
ing
reas
on:
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
Sig
natu
re O
f Dis
trict
Cou
rt Ju
dge
The
unde
rsig
ned
defe
ndan
t, w
ith th
e co
nsen
t of h
is/h
er a
ttorn
ey, w
aive
s th
e rig
ht to
a p
roba
ble
caus
e he
arin
g.S
igna
ture
Of D
efen
dant
Sig
natu
re O
f Atto
rney
B
y ar
rest
ing
the
defe
ndan
t and
brin
ging
the
defe
ndan
t bef
ore:
T
his
Ord
er W
AS
NO
T se
rved
for t
he fo
llow
ing
reas
on:
Sig
natu
re O
f Offi
cer M
akin
g R
etur
n
Nam
e O
f Jud
icia
l Offi
cial
Dat
e
Nam
e O
f Jud
icia
l Offi
cial
Dat
e
Dep
artm
ent O
r Age
ncy
Of O
ffice
r
Dep
artm
ent O
r Age
ncy
Of O
ffice
r
AM PM
Tim
e S
erve
dD
ate
Ser
ved
Dat
e R
etur
ned
Dat
e S
erve
dD
ate
Ret
urne
dAM PM
Tim
e S
erve
d
(TYPE OR PRINT IN BLACK INK)
Additional File Nos.
Material opposite unmarked squares is to be disregarded as surplusage.
District Superior Court Division
Permanent Mailing Address Of Defendant, Petitioner, Respondent (If Different Than Above)
Name Of Defendant, Petitioner, Respondent
ORDER OF ASSIGNMENT OR
DENIAL OF COUNSEL
Street Address Of Defendant, Petitioner, Respondent
In The General Court Of JusticeCounty
File No.
STATE OF NORTH CAROLINA
AOC-CR-224, Rev. 6/12© 2012 Administrative Office of the Courts
will not receive an active or suspended term of imprisonment if he/she is convicted of the offense(s) for which he/sheis charged; it is ORDERED that the defendant's petition is denied.
is not financially able to provide the necessary expenses of legal representation; it is ORDERED that theapplicant is an indigent and is entitled to the services of counsel as contemplated by law, and that he/she shall be represented by: the attorney named below. the public defender in this judicial district.
is financially able to provide the necessary expenses of legal representation; it is ORDERED that the applicantis not an indigent and his/her petition is denied.
will not receive an active or suspended term of imprisonment if he/she is found in contempt; it is ORDERED that the defendant's petition is denied.
Judge
1.
4.
3.
2.
Telephone Number of Defendant, Petitioner, Respondent
Check here if defendant is in jail
Full Social Security No. Has No Social Security No.
- - G.S. 7A-146(11), 7A-292(15), 7A-450, 7A-451(a)Offense(s) (List Offense(s) Only If File No. Has Not Been Assigned)
INSTRUCTIONS: Do not use this form for first-degree murder cases or murder cases where the degree is undesignated, except for cases where the defendant was under 18 years of age at the time of the offense, or for capital post-conviction cases or appeals to the Court of Appeals or Supreme Court. For adult first-degree murder cases or murder cases where the degree is undesignated at the trial level, the Office of Indigent Defense Services will use form AOC-CR-624. For capital post-conviction cases, the Office of Indigent Defense Services will use form AOC-CR-625. For appellate cases, the Court will use form AOC-CR-350.
From the petition heard in this matter, it appears to the Court that the applicant named above is party to a proceeding or action listed in G.S. 7A-451(a); and, from the affidavit made by the applicant, and from the inquiry made by the Court, which is documented in the record, itis determined that the applicant:
I. ASSIGNMENT OR DENIAL OF COUNSEL
Next Court DateName Of Appointed Attorney (If Applicable)
II. SIGNATURE OF JUDGE, CLERK OR MAGISTRATE Date Signature
NOTE: A magistrate who is a duly licensed attorney may appoint counsel if designated to do so by the Chief District Court Judge. See G.S. 7A-146(11) and G.S. 7A-292(15).
Asst. CSC MagistrateClerk Of Superior Court Deputy CSC
Forms-Pg 31
Forms-Pg 32
Employment - Applicant
$$
Total Monthly Income $
STATE OF NORTH CAROLINA
File No.
$
Car Expenses(gas, insurance, etc.)
Shelter
Other: (specify)
FoodUtilities(power, water, heating, phone, cable, etc.)
Health Care
Installment Payments
Support Payments
$
$
Total Monthly Expenses
(Fair Market Value)
(Fair Market Value)
$
$
$(Fair Market Value)
(Balance Due)
Total Assets And Liabilities
Money Owed To Or Held For Applicant
(Over)
Number Of Dependents
Personal Property
Real Estate
Motor Vehicles (List Make, Model, Year)
Cash On Hand And In Bank Accounts(List Name Of Bank & Account No.)
DESCRIPTION OF ASSETS AND LIABILITIES
(Balance Due)
(Balance Due)
ASSETS(things you own)
LIABILITIES(amounts you owe)
$
$
$
$Vehicle Other
$
$
Name And Address Of Applicant's Employer (If not employed, state reason; if self-employed, state trade)
Other Income (Welfare, Food Stamps, S/S, Pensions, etc.)
Employment - Spouse
Buying Renting
Name And Address Of Spouse's Employer
$
$
$
$
$
$
$
MONTHLY EXPENSES (money you pay out)
Applicant: Do you have other pending criminal charge(s)in which a lawyer has been appointed? Yes No
Last Income Tax Filed 20
Other Debts
Other
Bond Type
AOC-CR-226, Rev. 6/12© 2012 Administrative Office of the Courts
By Whom Posted
$
$
$
Full Social Security No. Of ApplicantHas No Social Security No.--
Name Of Lawyer
MONTHLY INCOME (money you make)
Refund Owe $
$
Amount
NOTE: Read the notice on the reverse side before completing this form.
(TYPE OR PRINT IN BLACK INK)
CountyName Of Applicant
AFFIDAVIT OF INDIGENCYG.S. 7A-450 et seq.
Additional File Nos.
In The General Court Of JusticeDistrict Superior Court Division
Full Street Address Of Applicant Including City, State And Zip Code
Full Permanent Mailing Address Of Applicant (If Different Than Above)
$
$
Offense(s)
Defendant Parent/Guardian/Trustee
Date Of BirthTelephone Number Of Applicant
Forms-Pg 33
County Where Notarized
Deputy CSC Assistant CSC Clerk Of Superior Court Magistrate
If you are less than 18 years old, or if you are at least 18 years old but remain dependent on and live with a parent or guardian, state name and address of parent, guardian or trustee below.
NOTE:
Name Of Parent/Guardian Or Trustee
Address
City, State, Zip
Notary
SEAL
SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE MEDate
Defendant Parent/Guardian/Trustee
The information you provide may be verified, and your signature below will serve as a release permitting the interviewer to contact your creditors, employers, family members, and others concerning your eligibility for a court-appointed lawyer. A false or dishonest answer concerning your financial status could lead to prosecution for perjury. See G.S. 7A-456(a) ("A false material statement made by a person under oath or affirmation in regard to the question of his indigency constitutes a Class I felony.").
3.
Signature Signature Of Applicant
Date
Name Of Applicant (Type Or Print)
Date My Commission Expires
Governmental Agencies Or Other Entities Authorized To Be Contacted And/Or To Release Information
Under penalty of perjury, I declare that the information provided on this form is true and correct to the best of my knowledge, and that I am financially unable to employ a lawyer to represent me. I now request the Court to assign a lawyer to represent me in this case. I authorize the Court to contact my creditors, employers, or family members, any governmental agencies or any other entities listed below concerning my eligibility for a court-appointed lawyer.
AOC-CR-226, Side Two, Rev. 6/12© 2012 Administrative Office of the Courts
NOTICE TO PERSONS REQUESTING A COURT-APPOINTED LAWYER
When answering the questions on the Affidavit Of Indigency (reverse side of this form), please do not discuss your case with the interviewer. The interviewer can be called as a witness to testify about any statements made in his/her presence. Please wait and speak with your lawyer. Do not ask the interviewer for any advice or opinion concerning your case.
1.
A court-appointed lawyer is not free. If you are convicted or plead guilty or no contest, you may be required to repay the cost of your lawyer as a part of your sentence. The Court may also enter a civil judgment against you, which will accrue interest at the legal rate set out in G.S. 24-1 from the date of the entry of judgment. Your North Carolina Tax Refund may be taken to pay for the cost of your court-appointed lawyer. In addition, if you are convicted or plead guilty or no contest, the Court must charge you an attorney appointment fee and may enter this fee as a civil judgment against you pursuant to G.S. 7A-455.1.
2.
I further authorize my creditors, employers, or family members, any governmental agencies or any other entities listed below to release financial information concerning my eligibility for a court-appointed lawyer upon request of the Court.
Forms-Pg 34
Attached please find an Order For Arrest Criminal Summons Warrant For Arrest for execution in yourcounty or city.
The judicial official who issued the process has made the following recommendations for conditions of release:
STATE OF NORTH CAROLINA
AOC-CR-236, Rev. 4/01© 2001 Administrative Office of the Courts
TRANSMITTAL OFOUT-OF-COUNTY PROCESS
County
STATE VERSUS
File No.
In The General Court Of JusticeDistrict Superior Court Division
TO THE LAW ENFORCEMENT AGENCY NAMED ABOVE:
Signature
AM PM
Location of Hearing
Name And Address Of Law Enforcement Agency
Date Of Hearing Time Of Hearing
Date
NOTE TO EXECUTING OFFICER:
Superior Court JudgeAssistant CSC
District Court JudgeDeputy CSC
CSCMagistrate
Following execution of the attached process, deliver this form to the judicial official before whom defendant is brought.
The judicial official in your county before whom the defendant is brought should set the trial or hearing at the date, time and location shown below.
If the defendant is committed to jail, the person or agency listed below should be contacted for return to this county.
Name Of Person Or Agency
Telephone No.
Name Of Defendant
Forms-Pg 36
STATE OF NORTH CAROLINA File No.
Name Of Defendant
The initiating officer's next court date(s) are shown above.
We have entered the following notation in the Return of Service on the original: "Defendant has been arrested in (name of county where defendant arrested) County."
The original of the process attached to this verification is in our physical possession.The process is still outstanding and has not already been served on the defendant.The defendant is still wanted for prosecution on these charges.
The defendant was arrested in the County of Arrest named above. The attached process defendant. The process is hereby recalled. If you have not already done so, immediately return your original to the office of the Clerk of Superior Court of the county in which the charges are pending.
(Over)
In The General Court Of JusticeCountyDistrict Superior Court Division
AOC-CR-241, Rev. 3/05© 2005 Administrative Office of the Courts
NOTE: The county name shown above is the county where the process was originally issued. See instructions on reverse side.
OUT-OF-COUNTY PROCESS VERIFICATIONRECALL AND TRANSMISSION
(For use when process electronically transmitted to out-of-county agency)
G.S. 15A-101.1; 15A-401; 15A-501
I. VERIFICATIONType Of Process
Warrant Order For ArrestDate Of Issuance Of Process
NOTICE TO THE LAW ENFORCEMENT AGENCY THAT ARRESTED THE DEFENDANT:The initiating law enforcement agency named below hereby verifies that:
Initiating Officer's Court Date(s)Name Of Initiating Officer, If Any
1.2.3.4.
5.
Offense(s) Charged Domestic Violence Offense
SignatureDate
Name Of Initiating Law Enforcement Agency Name (Type Or Print)
Fax Number of Initiating Law Enforcement Agency Title (Type Or Print)
II. RECALL OF PROCESS AND TRANSMISSION TO CLERKCounty Of Arrest, As Assigned By The Undersigned Date Of Arrest Date Of Service Of Process
Defendant's Next Court Date In Your CountyName And Address Of Arresting Agency
NOTICE TO THE LAW ENFORCEMENT AGENCY IN VERIFICATION SECTION ABOVE:
The defendant named above has been arrested on the charges specified above and served with a copy of the process in this county. The original process has been recalled. Attached you will find the following:
NOTICE TO THE CLERK OF SUPERIOR COURT OF THE COUNTY WHERE THE PROCESS WAS ISSUED:
has not been served on thehas
The process served in this county, bearing the officer's return of service.1.
The defendant's next court date in your county is the date shown above, and the defendant has been notified of that court date in the Release Order, of which a copy is attached.
The original release order and appearance bond, if the defendant has been released, or a copy of the release order, if the defendant has not been released.
3.
2.
Signature Of Judicial Official
Name Of Judicial Official (Type Or Print)Telephone Number
Date
County
Send the above by fax and hard mail in all cases.Send a copy of this form to the law enforcement agency in possession of the original process. Attach a copy of the Release Order.
Assign a court date in the county where the charges are pending. Communicate with that county to obtain an appropriate date. Enter this date under "Defendant's Next Court Date In Your County, As Assigned By The Undersigned."
AOC-CR-241, Side Two, Rev. 3/05© 2005 Administrative Office of the Courts
INSTRUCTIONS
THE LAW ENFORCEMENT AGENCY IN POSSESSION OF THE ORIGINAL PROCESS SHOULD:Enter the applicable information in the boxes in the top portion and in the Verification on the reverse side.1.
If the charges are all misdemeanor(s), under "Initiating Officer's Court Date(s)" enter all the dates on which the initiating officer is scheduled to be in district court during the next month. Otherwise do not enter a date in this box.
3.
Complete and sign the Verification on the reverse.4.Fax this form, and the process, to the law enforcement agency that arrested the defendant.5.
Immediately return the original, with that notation, to the office of the Clerk of Superior Court of the county where the process was issued, to be filed in the defendant's file.
7.
Make no further effort to arrest the defendant on this process.8.If you entered the defendant and the charges in DCI, update DCI with the arrest information.9.
Enter the following notation in the Return of Service on the original: "Defendant has been arrested in (name of county where defendant arrested) ____________ County."
6.
THE LAW ENFORCEMENT AGENCY THAT ARRESTED THE DEFENDANT SHOULD:
Make a copy of the process, serve it on the defendant, and make a return of service on the original or duplicate original.
the original process,this form, with the Verification on Side One of this form completed and signed.
By fax or other means, obtain the following from the law enforcement agency in possession of the process:1.a.b.
2.Take the defendant, and these papers, to a magistrate for an initial appearance without unnecessary delay. 3.
4. Give the process bearing your return of service and two (2) copies of this form to the magistrate.Notify DCI that the defendant has been arrested on these charges, if the process was entered.5.
Enter the applicable information in the boxes under "RECALL OF PROCESS AND TRANSMISSION TO CLERK."1.THE MAGISTRATE SHOULD:
Conduct an initial appearance immediately and set conditions of pretrial release as soon as sufficient information is available. 2.3.
Release the defendant upon satisfaction of the conditions of pretrial release.Complete the "Recall Of Process And Transmission To Clerk" on the reverse.Send this form to the Clerk of Superior Court of the issuing county. Attach the following:
4.5.
the process bearing the return of service,the original release order and appearance bond, if the defendant has been released from jail, or a copy of the release order if the defendant has not been released.
6.a.b.
7.8.
Under "Name Of Initiating Officer, If Any," enter the name of the officer whose name appears as a complaining witness on the warrant in this case, if any. If the process is an order for arrest, refer to the warrant for this information.
2.
Date
File No.STATE OF NORTH CAROLINA
Time
Time
The period of detention under this Order shall not exceed twenty-four (24) hours.
a sober, responsible adult is willing and able to assume responsibility for the defendant until the defendant's physical and mental faculties are no longer impaired.
2.
DETENTION ORDERBased upon the foregoing findings, the undersigned judicial official ORDERS that the defendant be detained in the custody of the Sheriff until an appropriate judicial official determines that
the defendant's physical and mental faculties are no longer impaired to the extent that the defendant presents a danger of physical injury to the defendant or others or of damage to property if the defendant is released or
1.
Clerk Of Superior Court
District Court Judge
Superior Court Judge
Magistrate
Deputy CSC
Assistant CSC
PMAM
Signature Of Judicial Official
the defendant's physical and mental faculties are no longer impaired to the extent that the defendant presents a danger of physical injury to the defendant or others or of damage to property if the defendant is released.
(name), a sober, responsible adult, has indicated by signing below that he/she is willing and able to assume responsibility for the defendant until the defendant's physical and mental faculties are no longer impaired.
the period of detention has reached twenty-four (24) hours.
The undersigned judicial official ORDERS that the defendant be released from the detention order entered above because
By signing immediately below, I certify that I am a sober, responsible person, age 18 or older, who is willing and able to assume responsibility for the defendant until the defendant's physical or mental faculties are no longer impaired.
1.
3.
2.
RELEASE FROM DETENTION ORDER
Date
Date
The conditions, if any, of the defendant's pretrial release are contained on form AOC-CR-200.
Signature Of Judicial Official
PMAM Clerk Of Superior Court
District Court Judge
Superior Court Judge
Magistrate
Deputy CSC
Assistant CSC
Signature Of Sober Responsible Adult
"If there is a finding of probable cause, the magistrate shall consider whether the person is impaired to the extent that the provisions of G.S. 15A-534.2 should be imposed." G.S. 20-38.4(a)(3).
NOTE:
Name Of Defendant
AOC-CR-270, Rev. 6/12© 2012 Administrative Office of the Courts
Date Of Birth
In The General Court Of JusticeCounty District Superior Court Division
The defendant has been charged with an offense involving impaired driving as defined in G.S. 20-4.01(24a).1.
The undersigned judicial official conducting an initial appearance for the defendant named above finds the following by clear and convincing evidence:
DETENTION OF IMPAIRED DRIVER
STATE VERSUS
G.S. 15A-534.2, 20-38.4FINDINGS
At the time of the defendant's initial appearance, the impairment of the defendant's physical or mental faculties presents a danger, if the defendant is released, of physical injury to the defendant or others or damage to property in that (specify reasons):
2.
Forms-Pg 39
Date
public health officials have completed their investigation and testing, if any, under G.S. 130A-144 and G.S. 130A-148.
File No.STATE OF NORTH CAROLINA
the period of detention has reached twenty-four (24) hours.
The undersigned judicial official ORDERS that the defendant be released from the detention order entered above because
Date
1.
2.
Clerk Of Superior Court
District Court Judge
Superior Court Judge
Magistrate
Deputy CSC
Assistant CSC
PMAM
Clerk Of Superior Court
District Court Judge
Superior Court Judge
Magistrate
Deputy CSC
Assistant CSC
PMAM
Signature Of Judicial Official
Time
RELEASE FROM DETENTION ORDER
The conditions, if any, of the defendant's pretrial release are contained on form AOC-CR-200.
Signature Of Judicial Official
Time
DETENTION ORDERBased upon the foregoing findings, the undersigned judicial official ORDERS that the defendant be detained in the custodyof the Sheriff to allow for investigation by public health officials and for testing for AIDS virus infection and Hepatitis B infection if required by public health officials pursuant to G.S. 130A-144 and G.S. 130A-148.
The period of detention under this Order shall not exceed twenty-four (24) hours.
Name Of Defendant
Date Of Birth
In The General Court Of JusticeCountyDistrict Superior Court Division
AOC-CR-270, Side Two, Rev. 6/12© 2012 Administrative Office of the Courts
The undersigned judicial official conducting an initial appearance or first appearance for the defendant named above finds probable cause that an individual had a nonsexual exposure to the defendant in a manner that poses a significant risk of transmission of the AIDS virus or Hepatitis B by the defendant to the individual in that (specify reasons):
DETENTION FOR COMMUNICABLEDISEASE TESTING
STATE VERSUS
G.S. 15A-534.3
FINDINGS
[NOTE: Do not include any information indicating that the defendant has or may have a communicable disease. Describe only the nature of the exposure that would pose a significant risk of transmission of the AIDS or Hepatitis B virus if the defendant were infected.Note that mere contact of the defendant’s bodily fluids with a subject’s clothing or unbroken skin does not pose a significant risk oftransmission of either virus. A significant risk of transmission occurs when the defendant’s bodily fluids come into contact with the subject’s broken skin or mucous membranes. For example, a bite by the defendant that does not break the subject’s skin does not posea significant risk of transmission. Contact that may pose a significant risk includes things like a needlestick or a bite that actually breaksthe subject’s skin.]
Forms-Pg 40
File No.STATE OF NORTH CAROLINA
Signature Of Magistrate
AM
AM PM
MagistrateDeputy CSC
Assistant CSCClerk Of Superior Court
NOTE: If a defendant charged with an implied consent offense is unable to make bond, the magistrate must (1) inform the defendant in writing of the established procedure to have others appear at the jail to observe the defendant's condition or administer an additional chemical analysis and (2) require the defendant to list all persons the defendant wishes to contact and their telephone numbers. A copy of this form must be placed in the case file. G.S. 20-38.4(a)(4).
Date Time
The defendant returned this form to the undersigned after the initial appearance.Date
CONTACT PERSONSTO THE DEFENDANT:
I do not wish to contact anyone.
TO THE DEFENDANT:The established local procedure to contact other persons and have other persons appear at the jail to observe your condition oradminister an additional chemical analysis to you is provided in writing with this form and incorporated into this form by reference. You are hereby notified of this procedure.
IMPLIED CONSENT OFFENSE NOTICESTATE VERSUS
G.S. 20-38.4
Name Of Defendant
OBSERVATION PROCEDURE
Date Signature Of Defendant
SIGNATUREBy signing below, the defendant indicates that he/she has received notice of the contact and observation procedure and has listed all persons that he/she wishes to contact.
County In The General Court Of JusticeBefore The Magistrate
AOC-CR-271, New 12/06© 2006 Administrative Office of the Courts
Pursuant to G.S. 20-38.4(a)(4), you are required to list all persons you wish to contact and their telephone numbers: (attach additional sheets if necessary)
Name Telephone Number
1.
2.
3.
The undersigned magistrate certifies that pursuant to Article 24 of Chap. 15A and G.S. 20-38.4 that1. An initial appearance was held and the undersigned found probable cause to believe the defendant committed an implied consent
offense.2. The undersigned reviewed all alcohol screening tests, chemical analyses and testimony from law enforcement officers concerning
impairment and the circumstances of the arrest, and observed the defendant.3. The undersigned considered whether the defendant was impaired to the extent that the provisions of G.S. 15A-534.2 should have
been imposed.
4. The undersigned informed the defendant in writing of the established procedure to have others appear at the jail to observe the defendant's condition or to administer an additional chemical analysis.
5. The undersigned required the defendant to list all persons the defendant wishes to contact and telephone numbers on a copy of this form.
The defendant returned this form to the undersigned at the initial appearance.The defendant failed to return this form at the initial appearance.
MAGISTRATE'S CERTIFICATION
Signature PM
Time
Forms-Pg 42
there is insufficient information to determine whether the defendant poses a danger to the public, and therefore makes the following additional findings and orders below. (NOTE: Nos. 3.a. and 3.b. must be completed when making this finding.)
3.
The custodian of the detention facility named on the attached AOC-CR-200 is ORDERED to detain the defendant pursuant to G.S. 15A-534(d2)(3). The custodian is further ORDERED to bring the defendant before a judge for first appearance at the location, date and time specified on the attached AOC-CR-200, but if the information identified in No. 3.b. becomes available before that time, the custodian is ORDERED to bring the defendant immediately before any judicial official to set conditions of release.
The undersigned finds the following basis for the decision that additional information is needed to determine whether the defendant poses a danger to the public:
The undersigned further finds that the following additional information is necessary to make that determination:
c.
a.
b.
upon review of the defendant's eligibility for release at his/her first appearance, upon receipt and consideration of the additional information described above, 1.
2.
NOTE TO JUDICIAL OFFICIAL: First appearance must be set for the first regular session of district court in the county or within 96 hours of arrest, whichever occurs first. G.S. 15A-601(c). A lack of information to determine whether the defendant poses a danger to the public does not permit a delay of the first appearance. If the defendant was detained pursuant to No. 3 above, then upon receipt of information identified in No. 3.b., any judicial official before whom the defendant is brought must set conditions of release pursuant to G.S. 15A-534(d2)(3), in accord with the official's further finding concerning danger to the public under Release From Detention Order above.
Magistrate Deputy CSC Assistant CSC Clerk Of Superior Court District Court Judge Superior Court Judge
Date Signature Of Judicial Official
The undersigned judicial official ORDERS that the defendant be released from the Detention Order entered above, because (check one)
RELEASE FROM DETENTION ORDER
the undersigned finds that the defendant does does not pose a danger to the public, and therefore sets or denies conditions of release accordingly on the attached AOC-CR-200.
Date
Magistrate Deputy CSC Assistant CSC Clerk Of Superior Court District Court Judge Superior Court Judge
Signature Of Judicial Official
NOTE: This order is required only if the defendant was detained pursuant to No. 3, above.
the defendant poses a danger to the public, and therefore a secured bond or electronic house arrest with secured bond is required if release is otherwise authorized.
1.
the defendant does not pose a danger to the public, and therefore conditions of release are set on the attached AOC-CR-200 as otherwise provided in G.S. Chapter 15A, Article 26.
2.
Name Of DefendantDETENTION OF PROBATIONER
ARRESTED FOR FELONY
Use this form in conjunction with form AOC-CR-200, Conditions Of Release And Release Order.NOTE:
AOC-CR-272, Rev. 3/10© 2010 Administrative Office of the Courts
In The General Court Of JusticeCounty District Superior Court Division
The undersigned, having found on the attached AOC-CR-200, incorporated herein by reference, that the defendant has been charged with a felony offense while on probation for a prior offense, hereby finds in addition that (check only one)
FINDINGS AND DETENTION ORDER
STATE VERSUS
G.S. 15A-534(d2)
.
.
File No.STATE OF NORTH CAROLINA
It is further ORDERED that, if conditions of release have not been set based upon the receipt of additional information by (date) at am pm (no later than 7 days from arrest), the custodian shall bring the defendant immediately before any judicial official at that time to set conditions of release.
The undersigned ORDERS that the custodian of the detention facility named on the attached AOC-CR-200 detain the defendant pursuant to G.S. 15A-1345(b1)(3), in order for the court to obtain sufficient information to determine whether the defendant poses a danger to the public.
upon receipt and consideration of additional information,
AOC-CR-272, Side Two, Rev. 3/10© 2010 Administrative Office of the Courts
b.
a.
Date
Magistrate Deputy CSC Assistant CSC Clerk Of Superior Court District Court Judge Superior Court Judge
the defendant does not pose a danger to the public, and therefore conditions of release are set on the attached AOC-CR-200 as otherwise provided in G.S. Chapter 15A, Article 26.
2.
the defendant poses a danger to the public, and therefore release is denied pending the defendant's probation revocation hearing as ordered on the attached AOC-CR-200 and pursuant to G.S. 15A-1345(b1)(1).
1.
Use this form in conjunction with form AOC-CR-200, Conditions Of Release And Release Order.NOTE:
The undersigned, having found on the attached AOC-CR-200, incorporated herein by reference, that the defendant has been arrested for a violation of probation with a pending felony charge or a prior conviction requiring registration under G.S. 14, Article 27A, hereby finds in addition that (check only one)
Name Of Defendant DETENTION OF DEFENDANT ARRESTED FOR PROBATION VIOLATION
WITH PENDING FELONYOR PRIOR SEX OFFENSE
In The General Court Of JusticeCounty District Superior Court Division
STATE VERSUS
G.S. 15A-1345(b1)
NOTE TO JUDICIAL OFFICIAL: If the defendant has been held for seven (7) days since arrest pursuant to G.S. 15A-1345(b1) and without a determination of conditions of release, the defendant must be brought before any judicial official, who must record in writing that the defendant has been held for 7 days and impose conditions of release as otherwise provided in G.S. 15A-1345. If the defendant is found to be a danger to the public, whether upon receipt of additional information or after 7 days without additional information, release must be denied pending the probation revocation hearing.
Date
the undersigned finds that the defendant does does not pose a danger to the public and therefore sets or denies conditions of release accordingly on the attached AOC-CR-200.
Magistrate Deputy CSC Assistant CSC Clerk Of Superior Court District Court Judge Superior Court Judge
Signature Of Judicial Official
1.upon review of the defendant's eligibility for release after detention without bail pursuant to G.S. 15A-1345(b1) as specified in No. 3.b. above,
2.
The undersigned judicial official ORDERS that the defendant be released from the Detention Order entered above, because (check one)
Signature Of Judicial Official
RELEASE FROM DETENTION ORDER
there is insufficient information to determine whether the defendant poses a danger to the public, and therefore enters the following Detention Order. (NOTE: A date and time for production of the defendant must be set in No. 3.b. when making this finding.)
3.
NOTE: This order is required only if the defendant was detained pursuant to No. 3, above.
FINDINGS AND DETENTION ORDER
File No.STATE OF NORTH CAROLINA
NO
RTH
CA
RO
LINA
UN
IFOR
M C
ITATIO
N
D.L. D
.C.I. O
ther
; (2) not operate a motor vehiclelonger
JUDGMENT: The defendant appeared in open court and freely, voluntarily and understandingly entered the above plea; on the above verdict/finding, it is ORDERED that the defendant:
guilty/resp.guilty/resp.not guilty/resp.
no contestno contest
No./Level: 0
AppointedRetainedWaived
Date O
f Arrest &
Check D
igit No. (A
s Show
n On Fingerprint C
ard)
10. By failing to see before (starting) (stopping) (turning from
a direct line) that such m
ovement could be m
ade in safety. G.S
. 20-154.11. B
y failing to stop at a duly erected (stop sign) (flashing red light). G
.S. 20-158(b)(1), (b)(3).
12. By entering an intersection w
hile a traffic signal was em
itting a steady red circular light for traffic in defendant's direction of travel. G
.S. 20-158(b)(2).
13. Without having in full force and effect the financial responsibility required by
G.S
. 20-313. The defendant was the ow
ner of the motor vehicle that w
as (registered) (required to be registered) in this S
tate. G.S
. 20-313.14. (P
ossess an open container of) (Consum
e) an alcoholic beverage in the passenger area of a m
otor vehicle. G.S
. 20-138.7(a1). [NO
TE: Strike "operate a
(motor) vehicle" and "(public vehicular area)" above.]
15. Without decreasing speed as necessary to avoid colliding w
ith a (vehicle) (person). G
.S. 20-141(m
).
Defendant Is To A
ppear In District C
ourt
Day O
f Week
Time
N.C
.AM
PM
Month
Day
Year
1. At a speed of M
PH
in a MP
H zone. G
.S. 20-141.
PRIOR CONVICTIONS:
In The General C
ourt Of Justice D
istrict Court D
ivision
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.The defendant in open court, gives notice of appeal to the Superior Court.
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.)
ACK
NO
WLED
GM
ENT/N
ON
RESID
ENT PER
SON
AL REC
OG
NIZAN
CE FO
R APPEAR
ANC
E
The current pretrial release order is modified as follows:
.
17. And on or about the date and tim
e shown above in the nam
ed county, the nam
ed defendant did unlawfully and w
illfully operate a (motor) vehicle on a (street
or highway) (public vehicular area)
It is ORDERED that this:
sentence is to run at the expiration of the sentence in
I acknowledge receipt of this C
itation and I promise to appear in the nam
ed court at the tim
e and place designated herein to answer the charge(s). I understand that m
y failure to appear or to dispose of this C
itation by other acceptable legal means, such as
waiver, w
ill result in my operator's license issued by m
y state of residence being suspended until I have done so. A
lso, I may go before a m
agistrate and make bail in lieu
of my personal recognizance.
State
DEPA
RTM
ENTA
L USE O
NLY
N.C
. Patrol
Refused
Traffic
77. work zone. G
.S. 20-141(j2).
88. school zone. G.S
. 20-141.1.
16.
4. By transporting a child of less than five years of age and less than 40
pounds in weight w
ithout the child being secured in the rear seat, when the vehicle
was equipped w
ith an active passenger-side front air bag and the vehicle had a rear seat. G
.S. 20-137.1(a1).
3. By transporting a passenger of less than 16 years of age w
ithout having the passenger in a (w
eight appropriate child passenger restraint system) (seat
belt). G.S
. 20-137.1.
2. In forward m
otion without having the provided seat belt properly fastened about
the defendant's body. G.S
. 20-135.2A.
8. While displaying an expired registration plate on the vehicle know
ing the same to
be expired. G.S
. 20-111(2).
6. Without being licensed as a driver by the D
ivision of Motor V
ehicles of North
Carolina. G
.S. 20-7(a).
7. While the defendant's drivers license w
as revoked. G.S
. 20-28.
5. While subject to an im
pairing substance. G.S
. 20-138.1.
Signature O
f Officer
Date
Officer
THE STA
TE OF N
OR
TH C
AR
OLIN
A VS.
STATE O
F NO
RTH
CA
RO
LINA
County
AC
Police/Sheriff
, in the named county, the nam
ed defendant did unlawfully and
The undersigned officer has probable cause to believe that on or about ,
(a.) (p.) m., the
day of
willfully operate a (m
otor) vehicle on a (street or highway) (public vehicular area)
,
Speed
Vis.
Wea.
Area
Chem
ical Analyst
No. O
f Charges
SH
P C
ode
On H
ighway N
o./Street
Accident
In Vicinity/C
ity Of
At/N
ear Intersection
Nam
e Of D
efendant
Address
ZipS
tateC
ity
State
CD
LC
lassD
rivers License No.
Age
Date O
f Birth
Sex
Race
Telephone No.
Social S
ecurity No. O
f Defendant
Vehicle License N
o.
Year
Make
Haz. M
at.C
MV
Trailer TypeV
ehicle Type
Nam
e And Telephone N
o. Of D
efendant's Em
ployerNo.
Troop
AO
C-C
R-500, R
ev. 3/10, © 2010 A
dministrative O
ffice of the Courts
District
DOC
I (0) II (1-4) III (5+)
COURT USE ONLY
Signature Of Magistrate/Deputy/Assistant/CSCThe named defendant has been arrested without a warrant and there is probable cause for the defendant's detention on the stated charges. This Magistrate's Order is issued upon information furnished under oath by the named officer. A copy of this Order has been delivered to the defendant.
I certify that thisJudgment is a true copy.
DateDate
Date
Signature Of District Court Judge Signature Of Deputy/Assistant/CSC
PLEA:
V/D
guilty/resp.guilty/resp.not guilty/resp.
case be consolidated for judgment with
MISD. CLASS:MISD. CLASS:
22
33
VERDICT/FINDING:
11
A1A1
.
District Attorney Attorney For Defendant At Time Of Trial Or Plea
pay
until properly licensed by DMV; (3) complete hours of community service within days and pay the fee; (4) Other:
Execution of sentence is suspended and the defendant is placed on unsupervised probation for months, subject to the regular conditions of probation and the following: (1) pay costs and a fine/penalty of $
costs and a fine/penalty of $ days in custody of the sheriff. Pretrial credit be imprisoned for a term of days served. The Court finds that ashorter period of probation than specified in G.S. 15A-1343.2(d) is necessary.
.
Judgment is continued upon payment of costs.
Signature O
f Defendant
Date
Injury Or S
erious InjuryP
assenger(s) Under 16
C
OR
IGIN
AL-C
OU
RT C
OPY
.
MAGISTRATE'S ORDER - MISDEMEANOR ONLY
.
9. Without (displaying thereon a current approved inspection certificate) (having a
current electronic inspection authorizaton for the vehicle), such vehicle requiring inspection in N
orth Carolina. G
.S. 20-183.8. M
onth Expired: .
Wit. File N
o.
WITN
ESSES
Nam
eA
ddressP
hone
Nam
eA
ddressP
hone
Nam
eA
ddressP
hone
File No.
NO
RTH
CA
RO
LINA
UN
IFOR
M C
ITATIO
N
D.L. D
.C.I. O
ther
; (2) not operate a motor vehiclelonger
JUDGMENT: The defendant appeared in open court and freely, voluntarily and understandingly entered the above plea; on the above verdict/finding, it is ORDERED that the defendant:
guilty/resp.guilty/resp.not guilty/resp.
no contestno contest
No./Level: 0
AppointedRetainedWaived
Date O
f Arrest &
Check D
igit No. (A
s Show
n On Fingerprint C
ard)
10. By failing to see before (starting) (stopping) (turning from
a direct line) that such m
ovement could be m
ade in safety. G.S
. 20-154.11. B
y failing to stop at a duly erected (stop sign) (flashing red light). G
.S. 20-158(b)(1), (b)(3).
12. By entering an intersection w
hile a traffic signal was em
itting a steady red circular light for traffic in defendant's direction of travel. G
.S. 20-158(b)(2).
13. Without having in full force and effect the financial responsibility required by
G.S
. 20-313. The defendant was the ow
ner of the motor vehicle that w
as (registered) (required to be registered) in this S
tate. G.S
. 20-313.14. (P
ossess an open container of) (Consum
e) an alcoholic beverage in the passenger area of a m
otor vehicle. G.S
. 20-138.7(a1). [NO
TE: Strike "operate a
(motor) vehicle" and "(public vehicular area)" above.]
15. Without decreasing speed as necessary to avoid colliding w
ith a (vehicle) (person). G
.S. 20-141(m
).
Defendant Is To A
ppear In District C
ourt
Day O
f Week
Time
N.C
.AM
PM
Month
Day
Year
1. At a speed of M
PH
in a MP
H zone. G
.S. 20-141.
PRIOR CONVICTIONS:
In The General C
ourt Of Justice D
istrict Court D
ivision
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.The defendant in open court, gives notice of appeal to the Superior Court.
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.)
ACK
NO
WLED
GM
ENT/N
ON
RESID
ENT PER
SON
AL REC
OG
NIZAN
CE FO
R APPEAR
ANC
E
The current pretrial release order is modified as follows:
.
17. And on or about the date and tim
e shown above in the nam
ed county, the nam
ed defendant did unlawfully and w
illfully operate a (motor) vehicle on a (street
or highway) (public vehicular area)
It is ORDERED that this:
sentence is to run at the expiration of the sentence in
I acknowledge receipt of this C
itation and I promise to appear in the nam
ed court at the tim
e and place designated herein to answer the charge(s). I understand that m
y failure to appear or to dispose of this C
itation by other acceptable legal means, such as
waiver, w
ill result in my operator's license issued by m
y state of residence being suspended until I have done so. A
lso, I may go before a m
agistrate and make bail in lieu
of my personal recognizance.
State
DEPA
RTM
ENTA
L USE O
NLY
N.C
. Patrol
Refused
Traffic
77. work zone. G
.S. 20-141(j2).
88. school zone. G.S
. 20-141.1.
16.
4. By transporting a child of less than five years of age and less than 40
pounds in weight w
ithout the child being secured in the rear seat, when the vehicle
was equipped w
ith an active passenger-side front air bag and the vehicle had a rear seat. G
.S. 20-137.1(a1).
3. By transporting a passenger of less than 16 years of age w
ithout having the passenger in a (w
eight appropriate child passenger restraint system) (seat
belt). G.S
. 20-137.1.
2. In forward m
otion without having the provided seat belt properly fastened about
the defendant's body. G.S
. 20-135.2A.
8. While displaying an expired registration plate on the vehicle know
ing the same to
be expired. G.S
. 20-111(2).
6. Without being licensed as a driver by the D
ivision of Motor V
ehicles of North
Carolina. G
.S. 20-7(a).
7. While the defendant's drivers license w
as revoked. G.S
. 20-28.
5. While subject to an im
pairing substance. G.S
. 20-138.1.
Signature O
f Officer
Date
Officer
THE STA
TE OF N
OR
TH C
AR
OLIN
A VS.
STATE O
F NO
RTH
CA
RO
LINA
County
AC
Police/Sheriff
, in the named county, the nam
ed defendant did unlawfully and
The undersigned officer has probable cause to believe that on or about ,
(a.) (p.) m., the
day of
willfully operate a (m
otor) vehicle on a (street or highway) (public vehicular area)
,
Speed
Vis.
Wea.
Area
Chem
ical Analyst
No. O
f Charges
SH
P C
ode
On H
ighway N
o./Street
Accident
In Vicinity/C
ity Of
At/N
ear Intersection
Nam
e Of D
efendant
Address
ZipS
tateC
ity
State
CD
LC
lassD
rivers License No.
Age
Date O
f Birth
Sex
Race
Telephone No.
Social S
ecurity No. O
f Defendant
Vehicle License N
o.
Year
Make
Haz. M
at.C
MV
Trailer TypeV
ehicle Type
Nam
e And Telephone N
o. Of D
efendant's Em
ployerNo.
Troop
AO
C-C
R-500, R
ev. 3/10, © 2010 A
dministrative O
ffice of the Courts
District
DOC
I (0) II (1-4) III (5+)
COURT USE ONLY
Signature Of Magistrate/Deputy/Assistant/CSCThe named defendant has been arrested without a warrant and there is probable cause for the defendant's detention on the stated charges. This Magistrate's Order is issued upon information furnished under oath by the named officer. A copy of this Order has been delivered to the defendant.
I certify that thisJudgment is a true copy.
DateDate
Date
Signature Of District Court Judge Signature Of Deputy/Assistant/CSC
PLEA:
V/D
guilty/resp.guilty/resp.not guilty/resp.
case be consolidated for judgment with
MISD. CLASS:MISD. CLASS:
22
33
VERDICT/FINDING:
11
A1A1
.
District Attorney Attorney For Defendant At Time Of Trial Or Plea
pay
until properly licensed by DMV; (3) complete hours of community service within days and pay the fee; (4) Other:
Execution of sentence is suspended and the defendant is placed on unsupervised probation for months, subject to the regular conditions of probation and the following: (1) pay costs and a fine/penalty of $
costs and a fine/penalty of $ days in custody of the sheriff. Pretrial credit be imprisoned for a term of days served. The Court finds that ashorter period of probation than specified in G.S. 15A-1343.2(d) is necessary.
.
Judgment is continued upon payment of costs.
Signature O
f Defendant
Date
Injury Or S
erious InjuryP
assenger(s) Under 16
C
DEFEN
DA
NT'S C
OPY (SEE IM
POR
TAN
T NO
TICE O
N R
EVERSE)
.
MAGISTRATE'S ORDER - MISDEMEANOR ONLY
.
9. Without (displaying thereon a current approved inspection certificate) (having a
current electronic inspection authorizaton for the vehicle), such vehicle requiring inspection in N
orth Carolina. G
.S. 20-183.8. M
onth Expired: .
Wit.
Signature O
f Defendant
WA
IVER O
F TRIA
L/HEA
RIN
G - PLEA
OF G
UILTY/R
ESPON
SIBLE - C
ON
SENT TO
ENTR
Y OF JU
DG
MEN
TI acknow
ledge that I have been charged with the offense/infraction noted
herein by the charging officer.
I understand that I am presum
ed by law to be N
ot Guilty/N
ot Responsible until
proven Guilty/R
esponsible beyond a reasonable doubt. Nevertheless, I do
hereby waive m
y constitutional rights to a trial/hearing in open court, to confront the w
itnesses against me, and to representation by an attorney.
I hereby plead Guilty/R
esponsible to this offense/infraction and tender to the court the sum
s listed below as paym
ent of the fine/penalty and costs in this case.
I request that the court accept my w
aiver of trial/hearing, plea of G
uilty/Responsible and tender of fine/penalty and costs, and that a
verdict/finding of Guilty/R
esponsible be entered. This request is made w
ith the full understanding that a verdict/finding of G
uilty/Responsible w
ill be entered against m
y record, that if this is a motor vehicle offense, the N
orth Carolina
Division of M
otor Vehicles (or the licensing authority of any other state which
issued my license to drive) w
ill be notified of the verdict/finding, that it will have
the same legal effect for all purposes as a verdict/finding of G
uilty/Responsible
after a trial/hearing, and that it may result in the assessm
ent of points on my
driving record or the suspension or revocation of my drivers license.
AOC
-CR
-500, Rev. 3/10, ©
2010 Administrative O
ffice of the Courts
Am
ount Of Fine/P
enaltyC
ourt Costs
Total
$$
$D
ate
appear in person before a Magistrate of
County, because of the
nature of the charge. Date and sign this C
itation in the space provided below
, deliver it to the Magistrate,
and pay the fine imposed by the M
agistrate and the court costs show
n below.
Payment m
ust be made by cash, certified check,
cashier's check or money order payable to the
Clerk of Superior C
ourt. PER
SON
AL C
HEC
KS W
ILL NO
T BE A
CC
EPTED.
WA
RN
ING
: If you decide to plead Guilty/R
esponsible, you should do so prom
ptly to minim
ize your court costs.If you delay in entering your plea and m
aking the specified paym
ent, you may be liable for the costs of
serving subpoenas on witnesses plus w
itness fees.
time and place specified on the front side.1. You m
ust appear in District C
ourt at the
Payment In Person - D
eliver your payment and this
Citation to the office of the C
lerk of Superior Court at
the above address during regular business hours or to any M
agistrate of the above county. Payment m
ustbe m
ade by cash, certified check, cashier's check or m
oney order payable to the Clerk of Superior
Court.
PERSO
NA
L CH
ECK
S WILL N
OT B
E AC
CEPTED
.
Do not m
ail cash. PERSO
NA
L CH
ECK
S WILL
NO
T BE A
CC
EPTED.
NO
TICE TO
DEFEN
DA
NT
If you fail to appear in court at the time and place specified, or to dispose of this case prior to your court date by pleading G
uilty/Responsible, crim
inal processm
ay be issued against you. If you are charged with a m
otor vehicle offense, your failure to appear may result in the revocation of your drivers license until
you dispose of this charge, and certain fees may be assessed against you. In addition, if a cash bond is required and posted, it w
ill be forfeited, and your failure to appear w
ill be treated as a "conviction" resulting in "points" against your record or possible license revocation.
INSTR
UC
TION
S TO D
EFEND
AN
T(O
nly the checked block applies)
2. You do not have to appear in District C
ourtat the tim
e and place specified if you waive your trial,
plead Guilty/R
esponsible and pay the amounts
shown below
for fine/penalty (which is a standard
amount set by the C
hief District C
ourt Judges of N
orth Carolina) and for court costs. You m
ay do so by m
ail, in person or online so long as your payment
is received by 5:00 p.m. on the last w
orking day prior to your scheduled court date.
Payment B
y Mail - D
ate and sign this Citation in the
space provided below, place your paym
ent and this C
itation in an envelope, affix a stamp and m
ail to: C
lerk of Superior Court,
County C
ourthouse, ,N
orth Carolina . Paym
ent must be
made by certified check, cashier's check or
money order payable to the C
lerk of Superior Court.
If you wish to contest the charge or appear before
a judge, you must appear at the tim
e and place specified on the front side.
at the time and place specified if you w
aive your trial and plead G
uilty. If you wish to do so, you m
ust
3. You do not have to appear in District C
ourt
If you wish to contest the charge or appear before
a judge, you must appear at the tim
e and place specified on the front side.
Payment O
nline - Certain offenses that do not
require a court appearance may be processed online
at ww
w.payN
Cticket.org.
File No.
NO
RTH
CA
RO
LINA
UN
IFOR
M C
ITATIO
N
D.L. D
.C.I. O
ther
; (2) not operate a motor vehiclelonger
JUDGMENT: The defendant appeared in open court and freely, voluntarily and understandingly entered the above plea; on the above verdict/finding, it is ORDERED that the defendant:
guilty/resp.guilty/resp.not guilty/resp.
no contestno contest
No./Level: 0
AppointedRetainedWaived
Date O
f Arrest &
Check D
igit No. (A
s Show
n On Fingerprint C
ard)
10. By failing to see before (starting) (stopping) (turning from
a direct line) that such m
ovement could be m
ade in safety. G.S
. 20-154.11. B
y failing to stop at a duly erected (stop sign) (flashing red light). G
.S. 20-158(b)(1), (b)(3).
12. By entering an intersection w
hile a traffic signal was em
itting a steady red circular light for traffic in defendant's direction of travel. G
.S. 20-158(b)(2).
13. Without having in full force and effect the financial responsibility required by
G.S
. 20-313. The defendant was the ow
ner of the motor vehicle that w
as (registered) (required to be registered) in this S
tate. G.S
. 20-313.14. (P
ossess an open container of) (Consum
e) an alcoholic beverage in the passenger area of a m
otor vehicle. G.S
. 20-138.7(a1). [NO
TE: Strike "operate a
(motor) vehicle" and "(public vehicular area)" above.]
15. Without decreasing speed as necessary to avoid colliding w
ith a (vehicle) (person). G
.S. 20-141(m
).
Defendant Is To A
ppear In District C
ourt
Day O
f Week
Time
N.C
.AM
PM
Month
Day
Year
1. At a speed of M
PH
in a MP
H zone. G
.S. 20-141.
PRIOR CONVICTIONS:
In The General C
ourt Of Justice D
istrict Court D
ivision
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.The defendant in open court, gives notice of appeal to the Superior Court.
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.)
ACK
NO
WLED
GM
ENT/N
ON
RESID
ENT PER
SON
AL REC
OG
NIZAN
CE FO
R APPEAR
ANC
E
The current pretrial release order is modified as follows:
.
17. And on or about the date and tim
e shown above in the nam
ed county, the nam
ed defendant did unlawfully and w
illfully operate a (motor) vehicle on a (street
or highway) (public vehicular area)
It is ORDERED that this:
sentence is to run at the expiration of the sentence in
I acknowledge receipt of this C
itation and I promise to appear in the nam
ed court at the tim
e and place designated herein to answer the charge(s). I understand that m
y failure to appear or to dispose of this C
itation by other acceptable legal means, such as
waiver, w
ill result in my operator's license issued by m
y state of residence being suspended until I have done so. A
lso, I may go before a m
agistrate and make bail in lieu
of my personal recognizance.
State
DEPA
RTM
ENTA
L USE O
NLY
N.C
. Patrol
Refused
Traffic
77. work zone. G
.S. 20-141(j2).
88. school zone. G.S
. 20-141.1.
16.
4. By transporting a child of less than five years of age and less than 40
pounds in weight w
ithout the child being secured in the rear seat, when the vehicle
was equipped w
ith an active passenger-side front air bag and the vehicle had a rear seat. G
.S. 20-137.1(a1).
3. By transporting a passenger of less than 16 years of age w
ithout having the passenger in a (w
eight appropriate child passenger restraint system) (seat
belt). G.S
. 20-137.1.
2. In forward m
otion without having the provided seat belt properly fastened about
the defendant's body. G.S
. 20-135.2A.
8. While displaying an expired registration plate on the vehicle know
ing the same to
be expired. G.S
. 20-111(2).
6. Without being licensed as a driver by the D
ivision of Motor V
ehicles of North
Carolina. G
.S. 20-7(a).
7. While the defendant's drivers license w
as revoked. G.S
. 20-28.
5. While subject to an im
pairing substance. G.S
. 20-138.1.
Signature O
f Officer
Date
Officer
THE STA
TE OF N
OR
TH C
AR
OLIN
A VS.
STATE O
F NO
RTH
CA
RO
LINA
County
AC
Police/Sheriff
, in the named county, the nam
ed defendant did unlawfully and
The undersigned officer has probable cause to believe that on or about ,
(a.) (p.) m., the
day of
willfully operate a (m
otor) vehicle on a (street or highway) (public vehicular area)
,
Speed
Vis.
Wea.
Area
Chem
ical Analyst
No. O
f Charges
SH
P C
ode
On H
ighway N
o./Street
Accident
In Vicinity/C
ity Of
At/N
ear Intersection
Nam
e Of D
efendant
Address
ZipS
tateC
ity
State
CD
LC
lassD
rivers License No.
Age
Date O
f Birth
Sex
Race
Telephone No.
Social S
ecurity No. O
f Defendant
Vehicle License N
o.
Year
Make
Haz. M
at.C
MV
Trailer TypeV
ehicle Type
Nam
e And Telephone N
o. Of D
efendant's Em
ployerNo.
Troop
AO
C-C
R-500, R
ev. 3/10, © 2010 A
dministrative O
ffice of the Courts
District
DOC
I (0) II (1-4) III (5+)
COURT USE ONLY
Signature Of Magistrate/Deputy/Assistant/CSCThe named defendant has been arrested without a warrant and there is probable cause for the defendant's detention on the stated charges. This Magistrate's Order is issued upon information furnished under oath by the named officer. A copy of this Order has been delivered to the defendant.
I certify that thisJudgment is a true copy.
DateDate
Date
Signature Of District Court Judge Signature Of Deputy/Assistant/CSC
PLEA:
V/D
guilty/resp.guilty/resp.not guilty/resp.
case be consolidated for judgment with
MISD. CLASS:MISD. CLASS:
22
33
VERDICT/FINDING:
11
A1A1
.
District Attorney Attorney For Defendant At Time Of Trial Or Plea
pay
until properly licensed by DMV; (3) complete hours of community service within days and pay the fee; (4) Other:
Execution of sentence is suspended and the defendant is placed on unsupervised probation for months, subject to the regular conditions of probation and the following: (1) pay costs and a fine/penalty of $
costs and a fine/penalty of $ days in custody of the sheriff. Pretrial credit be imprisoned for a term of days served. The Court finds that ashorter period of probation than specified in G.S. 15A-1343.2(d) is necessary.
.
Judgment is continued upon payment of costs.
Signature O
f Defendant
Date
Injury Or S
erious InjuryP
assenger(s) Under 16
CSHP D
IVISION
CO
PY/CSC
AU
DIT C
OPY
.
MAGISTRATE'S ORDER - MISDEMEANOR ONLY
.
9. Without (displaying thereon a current approved inspection certificate) (having a
current electronic inspection authorizaton for the vehicle), such vehicle requiring inspection in N
orth Carolina. G
.S. 20-183.8. M
onth Expired: .
Wit.
Forms-Pg 50
File No.
Date O
f Arrest &
Check D
igit No. (A
s Show
n On Fingerprint C
ard)
AM
PMD
.L. D.C
.I. Other
9. Without (displaying thereon a current approved inspection certificate) (having a
current electronic inspection authorizaton for the vehicle), such vehicle requiring inspection in N
orth Carolina. G
.S. 20-183.8. M
onth Expired: .
The named defendant has been arrested without a warrant and there is probable cause for the defendant's detention on the stated charges. This Magistrate's Order is issued upon information furnished under oath by the named officer. A copy of this Order has been delivered to the defendant.
N.C
.
ACK
NO
WLED
GM
ENT/N
ON
RESID
ENT PER
SON
AL REC
OG
NIZAN
CE FO
R APPEAR
ANC
E
AO
C-C
R-500, R
ev. 3/10, © 2010 A
dministrative O
ffice of the Courts
17. And on or about the date and tim
e shown above in the nam
ed county, the nam
ed defendant did unlawfully and w
illfully operate a (motor) vehicle on a (street
or highway) (public vehicular area)
I acknowledge receipt of this C
itation and I promise to appear in the nam
ed court at the tim
e and place designated herein to answer the charge(s). I understand that m
y failure to appear or to dispose of this C
itation by other acceptable legal means, such as
waiver, w
ill result in my operator's license issued by m
y state of residence being suspended until I have done so. A
lso, I may go before a m
agistrate and make bail in lieu
of my personal recognizance.
NO
RTH
CA
RO
LINA
UN
IFOR
M C
ITATIO
N
In The General C
ourt Of Justice D
istrict Court D
ivision
Signature Of Magistrate/Deputy/Assistant/CSC
OFFICER'S NOTES
MAGISTRATE'S ORDER - MISDEMEANOR ONLYDate
Defendant Is To A
ppear In District C
ourt
Day O
f Week
DEPA
RTM
ENTA
L USE O
NLY
N.C
. Patrol
Refused
Officer
THE STA
TE OF N
OR
TH C
AR
OLIN
A VS.
AC
Police/Sheriff
Month
Day
Year
Time
Speed
TrafficV
is.W
ea.A
rea
Chem
ical Analyst
No. O
f Charges
,
SH
P C
ode
On H
ighway N
o./Street
Accident
In Vicinity/C
ity Of
At/N
ear Intersection
Nam
e Of D
efendant
Address
ZipS
tateC
ity
State
CD
LC
lassD
rivers License No.
Age
Date O
f Birth
Sex
Race
Telephone No.
Social S
ecurity No. O
f Defendant
State
Vehicle License N
o.
Year
Make
Haz. M
at.C
MV
Trailer TypeV
ehicle Type
Nam
e And Telephone N
o. Of D
efendant's Em
ployerNo.
Troop
OFFIC
ER'S C
OPY
District
Date
Signature O
f Defendant
Injury Or S
erious InjuryP
assenger(s) Under 16
MP
H zone. G
.S. 20-141.
77. work zone. G
.S. 20-141(j2).
88. school zone. G.S
. 20-141.1.
10. By failing to see before (starting) (stopping) (turning from
a direct line) that such m
ovement could be m
ade in safety. G.S
. 20-154.11. B
y failing to stop at a duly erected (stop sign) (flashing red light). G
.S. 20-158(b)(1), (b)(3).
12. By entering an intersection w
hile a traffic signal was em
itting a steady red circular light for traffic in defendant's direction of travel. G
.S. 20-158(b)(2).
13. Without having in full force and effect the financial responsibility required by
G.S
. 20-313. The defendant was the ow
ner of the motor vehicle that w
as (registered) (required to be registered) in this S
tate. G.S
. 20-313.14. (P
ossess an open container of) (Consum
e) an alcoholic beverage in the passenger area of a m
otor vehicle. G.S
. 20-138.7(a1). [NO
TE: Strike "operate a
(motor) vehicle" and "(public vehicular area)" above.]
15. Without decreasing speed as necessary to avoid colliding w
ith a (vehicle) (person). G
.S. 20-141(m
).
16.
1. At a speed of
4. By transporting a child of less than five years of age and less than 40
pounds in weight w
ithout the child being secured in the rear seat, when the vehicle
was equipped w
ith an active passenger-side front air bag and the vehicle had a rear seat. G
.S. 20-137.1(a1).
3. By transporting a passenger of less than 16 years of age w
ithout having the passenger in a (w
eight appropriate child passenger restraint system) (seat
belt). G.S
. 20-137.1.
2. In forward m
otion without having the provided seat belt properly fastened about
the defendant's body. G.S
. 20-135.2A.
8. While displaying an expired registration plate on the vehicle know
ing the same to
be expired. G.S
. 20-111(2).
6. Without being licensed as a driver by the D
ivision of Motor V
ehicles of North
Carolina. G
.S. 20-7(a).
7. While the defendant's drivers license w
as revoked. G.S
. 20-28.
5. While subject to an im
pairing substance. G.S
. 20-138.1.
Signature O
f Officer
Date
MP
H in a
STATE O
F NO
RTH
CA
RO
LINA
County
AC
, in the named county, the nam
ed defendant did unlawfully and
The undersigned officer has probable cause to believe that on or about ,
(a.) (p.) m., the
day of
willfully operate a (m
otor) vehicle on a (street or highway) (public vehicular area)
,
C
Wit.
VIN
I consent to have this vehicle towed removed and stored
I, the undersigned, declare that I am the registered owner legal possessor
of the motor vehicle identified on the reverse of this Citation.
(check appropriate block)
by towing service
I consent to have this vehicle removed to the shoulder of the road by the undersigned law enforcement officer and left at this location.
Signature
Signature
.
Date
Date
CONSENT TO TOW, REMOVE OR STORE VEHICLE OR LEAVE VEHICLE AT THE SCENEAO
C-C
R-500, R
ev. 3/10, © 2010 A
dministrative O
ffice of the Courts
OFFIC
ER'S N
OTES
Date
The defendant shall refrain from removing, damaging or injuring the property listed below:
The defendant shall refrain from assaulting, beating, molesting, or wounding the alleged victim.The defendant shall stay away from the home, school, business or place of employment of the alleged victim.
3.
judge.The defendant may visit his or her child or children at times and places provided by the terms of any existing order entered by a 4.
2.1.
ORDERBased upon the foregoing findings, the undersigned judicial official ORDERS the following conditions of release IN ADDITION TO the conditions of release set out on the attached form AOC-CR-200:
MagistrateDistrict Court JudgeSuperior Court Judge
Signature Of Judicial Official
Name Of Defendant
File No.STATE OF NORTH CAROLINA
Use this form in conjunction with form AOC-CR-200, Conditions Of Release And Release Order.NOTE:
AOC-CR-630, Rev. 12/12© 2012 Administrative Office of the Courts
In The General Court Of JusticeCounty District Superior Court Division
The undersigned judicial official finds that the defendant named above is charged with assault on, stalking, communicating a threat to, or committing a felony provided in Articles 7A, 8, 10, or 15 of Chapter 14 of the General Statutes upon a spouse or former spouse or a person with whom the defendant lives or has lived as if married, with domestic criminal trespass, or with violation of an order entered pursuant to Chapter 50B, Domestic Violence, of the General Statutes.
FINDINGS
CONDITIONS OF RELEASE FOR PERSONCHARGED WITH A CRIMEOF DOMESTIC VIOLENCE
STATE VERSUS
G.S. 15A-534.1
The undersigned judicial official has considered the defendant's criminal history as shown on a criminal history report provided by a law enforcement officer or a district attorney. has not considered the defendant's criminal history as shown on a criminal history report because no report could be obtained within a reasonable time.
NOTE TO JUDICIAL OFFICIAL: The law enforcement officer or district attorney who provided the defendant's criminal history report shall dispose ofthe report in accordance with DCI regulations. The report shall NOT be placed in the case file.
The defendant shall have no contact with the alleged victim.The defendant shall comply with any valid domestic violence protective order in effect.The defendant shall not possess any firearms.Other:
Other restrictions:6.a.b.c.d.
#
(for offenses committed on or after December 1, 2012) The defendant shall abstain from alcohol, as verified by a continuous alcoholmonitoring system. The monitoring provider shall report any violation of this condition to the district attorney.
5.
Forms-Pg 53
Forms-Pg 54
Date
STATE OF NORTH CAROLINA
MagistrateDeputy CSCAssistant CSC
Clerk Of Superior CourtDistrict Court JudgeSuperior Court Judge
The defendant shall refrain from communicating or attempting to communicate, directly or indirectly, with the victim, except under circumstances specified in an order entered by a judge with knowledge of the pending charges. (Strike through and initial any waived conditions if block is checked, but not all conditions apply.)
3.
The defendant shall stay away from the home, temporary residence, school, business, or place of employment of the alleged victim. (Strike through and initial any waived conditions if block is checked, but not all conditions apply.)
ORDERBased upon the foregoing findings, the undersigned judicial official ORDERS the following conditions of release IN ADDITION TO the conditions of release set out on the attached form AOC-CR-200:
The defendant shall refrain from assaulting, beating, intimidating, stalking, threatening, or harming the alleged victim.1.
2.
Name Of Defendant
File No.
Signature Of Judicial Official
Use this form in conjunction with form AOC-CR-200, Conditions Of Release And Release Order.NOTE:
AOC-CR-631, New 6/08© 2008 Administrative Office of the Courts
In The General Court Of JusticeCountyDistrict Superior Court Division
The undersigned judicial official finds that the defendant named above is charged with felonious or misdemeanor child abuse, with takingindecent liberties with a minor in violation of G.S 14-202.1, with rape or any other sex offense in violation of Article 7A, Chapter 14 of the General Statutes, against a minor victim, with incest with a minor in violation of G.S. 14-178, with kidnapping, abduction, or felonious restraint involving a minor victim, with a violation of G.S. 14-320.1, with assault or any other crime of violence against a minor victim, or with communicating a threat against a minor victim.
The undersigned judicial official, upon request of the defendant, has waived one or more of the conditions required by No. 2 or No. 3 below based on the following findings that imposing the condition(s) on the defendant would not be in the best interest of the alleged victim: (specify reasons)
FINDINGS
CONDITIONS OF RELEASE FOR PERSON CHARGED WITH SEX OFFENSE OR CRIME OF
VIOLENCE AGAINST CHILD VICTIM
STATE VERSUS
G.S. 15A-534.4
Forms-Pg 56