Certificate -Warrant Or Affidavit {GOV.1-A}

FORM GOV. 1-A, Rev. 10/99 1999 Administrative Office of the Courts STATE OF NORTH CAROLINA CERTIFICATE STATE OF NORTH CAROLINA COUNTY OF I, , a duly appointed, qualified and acting Magistrate Proper Official of County, North Carolina, (address) , do hereby certify that the foregoing is a trueand correct copy of (1) the WARRANT issued by me on , , against , charging the said subject with the crime of , and (2) THE AFFIDAVIT on which the Warrant was issued. IN TESTIMONY WHEREOF, I have hereunto set my hand, this the day of , . Magistrate/Proper Official Attach Copy of Warrant, with Complaint or Affidavit on which it was issued, to each of the four (4) Sets of Application for Requisition at the end of the application by the (Assistant) District Attorney, said Copy being certified as shown above.