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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

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

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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

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ourt

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nC

ount

y

FBI N

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rt D

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ior C

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istra

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SC

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act

(s) w

as in

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the

law

(s) r

efer

red

to in

this

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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

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ECTE

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est t

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essa

ry d

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e ch

arge

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.

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ffice

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d ju

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ctio

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cute

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nt fo

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fens

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rged

bel

ow:

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AN

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Forms-Pg 1

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, add

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ount

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or a

ggrie

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(ies)

to re

ceiv

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stitu

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(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

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e W

aive

d

APP

EAL

ENTR

IES

guilt

ygu

ilty

guilt

yno

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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)

sjensen

Typewritten Text

Forms-Pg 2

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

sjensen

Typewritten Text

Forms-Pg 3

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)

sjensen

Typewritten Text

Forms-Pg 4

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.

sjensen

Typewritten Text

sjensen

Typewritten Text

Forms-Pg 5

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.

sjensen

Typewritten Text

Forms-Pg 6

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.

sjensen

Typewritten Text

Forms-Pg 7

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.

sjensen

Typewritten Text

Forms-Pg 8

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

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cop

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the

cost

s of

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GM

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titut

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unity

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vice

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APP

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The

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Oth

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CER

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MM

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that

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Cle

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Forms-Pg 10

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No.

STA

TE O

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Law

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men

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e N

o.

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rt D

ate

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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

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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

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fend

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amed

ab

ove

unla

wfu

lly, w

illful

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nd fe

loni

ousl

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d

sjensen

Typewritten Text

Forms-Pg 11

Dep

uty

CS

C

Ass

ist.

CS

C

C

SC

$$

The

Cou

rt fin

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lon

ger

sho

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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

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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

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atio

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ip

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ndan

t for

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tabl

e em

ploy

men

t, an

d ab

ide

by a

ll ru

les

of th

e in

stitu

tion.

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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.

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009A

dmin

istra

tive

Offi

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Cou

rts

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e W

aive

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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

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(Ove

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rmat

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by th

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rson

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MA

TTER

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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

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I cer

tify

that

this

Sea

rch

War

rant

was

rece

ived

and

exec

uted

as

follo

ws:

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ecei

ved

Dat

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ted

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omm

ande

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I sei

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item

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edin

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ny it

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War

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info

rty-e

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ourt

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lose

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sact

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usin

ess.

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sign

ing

belo

w, I

cer

tify

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ill d

eliv

er th

isS

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h W

arra

nt to

the

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rk o

f Sup

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r Cou

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app

licat

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to fi

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prop

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per

son

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ribed

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used

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[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


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:


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



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


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.

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Forms-Pg 21

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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

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Forms-Pg 22

SIGNATURE

Assistant CSC Clerk of Superior Court


AOC-CR-201A, Rev. 9/03 2003 Administrative Office of the Courts

STATE VERSUSFile No.

Name Of Defendant

ADDITIONAL ACCOMMODATION BONDSMAN


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.


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


Signature

ADDITIONAL ACCOMMODATION BONDSMANName 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)]


Social Security No.

Date

Social Security No.

Date

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Forms-Pg 23

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


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


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Forms-Pg 25

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:


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W C

AUSE

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DER

IN O

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INAL

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IMIN

AL J

UD

GM

ENT

[G.S

. 15A

-305

(b)(

8); -

1362

(c);

-136

4(a)

]th

e de

fend

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as fa

iled

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te s

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ts o

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ired

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men

t en

tere

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cas

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so fa

iled,

as

requ

ired

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h fa

ilure

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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

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se o

rder

and

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obab

le c

ause

to b

elie

ve th

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fend

ant w

ill no

t app

ear a

s re

quire

d in

resp

onse

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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

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emen

t, si

gned

by

the

prob

atio

n of

ficer

, al

legi

ng th

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fend

ant h

as v

iola

ted

spec

ified

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ditio

ns o

f the

def

enda

nt's

pro

batio

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d a

copy

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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

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Offe

nse

OR

DER

FO

R A

RR

EST

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orce

men

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e N

o.LI

D N

o.S

ID N

o.FB

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natu

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CC

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#

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r)A

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Typewritten Text

Forms-Pg 27

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,

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011

Adm

inis

trativ

e O

ffice

of t

he C

ourts

Dat

e W

aive

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APP

EAL

ENTR

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RED

ELIV

ERY/

REI

SSU

AN

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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

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erve

d as

follo

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WA

IVER

OF

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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

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ervi

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oted

ther

eon.

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offi

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mus

t sta

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ll st

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take

n by

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artm

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n at

tem

ptin

g to

ser

ve th

eor

der a

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outs

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ndan

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e R

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Dat

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I cer

tify

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er w

as re

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erve

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natu

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purp

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7.6.5.3. 4.1.FT

A - R

ELEA

SE O

RD

ER [G

.S. 1

5A-3

05(b

)(2)

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e de

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sec

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2.FT

A - C

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INAL

SU

MM

ON

S O

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ION

(Do

not u

se fo

r inf

ract

ion.

) [G

.S. 1

5A-3

05(b

)(3)

]th

e de

fend

ant h

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te s

how

n to

app

ear a

s re

quire

d by

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uly

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ons

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y a

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the

defe

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isde

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dete

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cond

ition

s of

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ase,

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efen

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TRU

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DIC

TMEN

T [G

.S. 1

5A-3

05(b

)(1)

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Gra

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ue b

ill of

indi

ctm

ent a

gain

st th

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fend

ant,

a co

py o

f whi

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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

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date

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wn

to a

ppea

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w C

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er e

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th

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rimin

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roce

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g.FT

A - S

HO

W C

AUSE

OR

DER

IN O

RIG

INAL

CR

IMIN

AL J

UD

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ENT

[G.S

. 15A

-305

(b)(

8); -

1362

(c);

-136

4(a)

]th

e de

fend

ant h

as fa

iled

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te s

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ne o

r cos

ts o

r bot

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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

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how

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se o

rder

and

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s pr

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le c

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ve th

at th

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fend

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s re

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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

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fend

ant h

as v

iola

ted

spec

ified

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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

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Offe

nse

OR

DER

FO

R A

RR

EST

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Enf

orce

men

t Cas

e N

o.LI

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o.S

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o.FB

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Sig

natu

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PM

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tion

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ourt

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CC

lerk

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uper

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ourt

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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

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f the

Cou

rts

sjensen

Typewritten Text

Forms-Pg 29

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:

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natu

re

T

his

Ord

er W

AS

NO

T se

rved

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he fo

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natu

re O

f Offi

cer M

akin

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etur

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natu

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f Dis

trict

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rt Ju

dge

The

unde

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ned

defe

ndan

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nsen

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is/h

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ttorn

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aive

s th

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natu

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d

sjensen

Typewritten Text

Forms-Pg 30

(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.



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 $


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


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.


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:



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

sjensen

Typewritten Text

Forms-Pg 35

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


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.


Name Of Judicial Official (Type Or Print)Telephone Number

Date

County

sjensen

Typewritten Text

Forms-Pg 37

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."


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.

sjensen

Typewritten Text

Forms-Pg 38

sjensen

Typewritten Text

sjensen

Typewritten Text

sjensen

Typewritten Text

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


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.


PMAM Clerk Of Superior Court



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


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.


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.




Magistrate

Deputy CSC

Assistant CSC

PMAM




Magistrate

Deputy CSC

Assistant CSC

PMAM


Time


The conditions, if any, of the defendant's pretrial release are contained on form AOC-CR-200.


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



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


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

sjensen

Typewritten Text

Forms-Pg 41

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)


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



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:



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)

.

.


sjensen

Typewritten Text

Forms-Pg 43

sjensen

Typewritten Text

sjensen

Typewritten Text

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,


b.

a.

Date


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.


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


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.



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)



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


sjensen

Typewritten Text

Forms-Pg 44

sjensen

Typewritten Text

sjensen

Typewritten Text

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


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.

sjensen

Typewritten Text

Forms-Pg 45

sjensen

Typewritten Text

sjensen

Typewritten Text

WITN

ESSES

Nam

eA

ddressP

hone

Nam

eA

ddressP

hone

Nam

eA

ddressP

hone

sjensen

Typewritten Text

Forms-Pg 46

File No.

NO

RTH

CA

RO

LINA

UN

IFOR

M C

ITATIO

N

D.L. D

.C.I. O

ther





No./Level: 0


Date O

f Arrest &

Check D

igit No. (A

s Show

n On Fingerprint C

ard)



ovement could be m

ade in safety. G.S

. 20-154.11. B


.S. 20-158(b)(1), (b)(3).




.S. 20-158(b)(2).


G.S




tate. G.S

. 20-313.14. (P



otor vehicle. G.S

. 20-138.7(a1). [NO





.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



ACK

NO

WLED

GM

ENT/N

ON

RESID

ENT PER

SON

AL REC

OG

NIZAN

CE FO

R APPEAR

ANC

E


.



ed county, the nam








ed court at the tim




waiver, w






State

DEPA

RTM

ENTA

L USE O

NLY

N.C

. Patrol

Refused

Traffic

77. work zone. G

.S. 20-141(j2).


. 20-141.1.

16.


pounds in weight w


was equipped w


.S. 20-137.1(a1).




belt). G.S

. 20-137.1.

2. In forward m



. 20-135.2A.


ing the same to

be expired. G.S

. 20-111(2).


ivision of Motor V

ehicles of North

Carolina. G

.S. 20-7(a).


as revoked. G.S

. 20-28.



. 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




(a.) (p.) m., the

day of



,

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



DateDate

Date


PLEA:

V/D




22

33

VERDICT/FINDING:

11

A1A1

.


pay




.


Signature O

f Defendant

Date

Injury Or S

erious InjuryP


C

DEFEN

DA

NT'S C

OPY (SEE IM

POR

TAN

T NO

TICE O

N R

EVERSE)

.


.



orth Carolina. G

.S. 20-183.8. M

onth Expired: .

Wit.

sjensen

Typewritten Text

Forms-Pg 47

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.

sjensen

Typewritten Text

Forms-Pg 48

File No.

NO

RTH

CA

RO

LINA

UN

IFOR

M C

ITATIO

N

D.L. D

.C.I. O

ther





No./Level: 0


Date O

f Arrest &

Check D

igit No. (A

s Show

n On Fingerprint C

ard)



ovement could be m

ade in safety. G.S

. 20-154.11. B


.S. 20-158(b)(1), (b)(3).




.S. 20-158(b)(2).


G.S




tate. G.S

. 20-313.14. (P



otor vehicle. G.S

. 20-138.7(a1). [NO





.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



ACK

NO

WLED

GM

ENT/N

ON

RESID

ENT PER

SON

AL REC

OG

NIZAN

CE FO

R APPEAR

ANC

E


.



ed county, the nam








ed court at the tim




waiver, w






State

DEPA

RTM

ENTA

L USE O

NLY

N.C

. Patrol

Refused

Traffic

77. work zone. G

.S. 20-141(j2).


. 20-141.1.

16.


pounds in weight w


was equipped w


.S. 20-137.1(a1).




belt). G.S

. 20-137.1.

2. In forward m



. 20-135.2A.


ing the same to

be expired. G.S

. 20-111(2).


ivision of Motor V

ehicles of North

Carolina. G

.S. 20-7(a).


as revoked. G.S

. 20-28.



. 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




(a.) (p.) m., the

day of



,

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



DateDate

Date


PLEA:

V/D




22

33

VERDICT/FINDING:

11

A1A1

.


pay




.


Signature O

f Defendant

Date

Injury Or S

erious InjuryP


CSHP D

IVISION

CO

PY/CSC

AU

DIT C

OPY

.


.



orth Carolina. G

.S. 20-183.8. M

onth Expired: .

Wit.

sjensen

Typewritten Text

Forms-Pg 49

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



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



ed county, the nam






ed court at the tim




waiver, w






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


MP

H zone. G

.S. 20-141.

77. work zone. G

.S. 20-141(j2).


. 20-141.1.



ovement could be m

ade in safety. G.S

. 20-154.11. B


.S. 20-158(b)(1), (b)(3).




.S. 20-158(b)(2).


G.S




tate. G.S

. 20-313.14. (P



otor vehicle. G.S

. 20-138.7(a1). [NO





.S. 20-141(m

).

16.

1. At a speed of


pounds in weight w


was equipped w


.S. 20-137.1(a1).




belt). G.S

. 20-137.1.

2. In forward m



. 20-135.2A.


ing the same to

be expired. G.S

. 20-111(2).


ivision of Motor V

ehicles of North

Carolina. G

.S. 20-7(a).


as revoked. G.S

. 20-28.



. 20-138.1.

Signature O

f Officer

Date

MP

H in a

STATE O

F NO

RTH

CA

RO

LINA

County

AC




(a.) (p.) m., the

day of



,

C

Wit.

sjensen

Typewritten Text

Forms-Pg 51

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

sjensen

Typewritten Text

Forms-Pg 52

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


Name Of Defendant





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


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.



AOC-CR-631, New 6/08© 2008 Administrative Office of the Courts


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

sjensen

Typewritten Text

Forms-Pg 55

Forms-Pg 56

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