Certificate -Warrant Certification {GOV.1-B}

FORM GOV. 1-B, Rev. 10/99 1999 Administrative Office of the Courts STATE OF NORTH CAROLINA CERTIFICATE STATE OF NORTH CAROLINA COUNTY OF I, , Clerk of the Superior Court of County, North Carolina, a court of record, do hereby certify: 1. That is the District Attorney Assistant District Attorney of the Prosecutorial District of North Carolina; and that the attached application for the requisition of has been signed by the above named District Attorney or Assistant District Attorney as aforesaid; 2. That , whose genuine signature appears upon the foregoingcertificate and warrant, was a duly appointed, qualified, and acting Magistrate Proper Official of County, North Carolina, at the time the said warrant was issued and the certificate executed. 3. That the attached warrant and affidavit, charging with the crime of ,is a true and correct copy of the warrant issued by the above named Magistrate or Proper Official as aforesaid, on , , and of the affidavit on which it was issued. IN WITNESS WHEREOF, I have hereunto set my hand and official seal of my said office, this the day of , . Clerk Of Superior Court (Seal of Court) County, North CarolinaAttach with Warrant Certification.