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Warrant For Arrest Employment Security Law Page 1 CR-915M1 - North Carolina
| Warrant For Arrest Employment Security Law Page 1 Form. This is a North Carolina form and can be used in Criminal Statewide . |
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File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Court Division WARRANT FOR ARREST EMPLOYMENT SECURITY LAW To any officer with authority and jurisdiction to execute a warrant for arrest for the offense charged below: I, the undersigned, find that there is probable cause to believe that on or about the date of offense shown and THE STATE OF NORTH CAROLINA VS. in the county named above the defendant named above unlawfully and willfully did make a false statement Name And Address Of Defendant and representation knowing it to be false, and did knowingly fail to disclose a material fact, in that the defendant reported to a representative of the Employment Security Commission of North Carolina the "Reported Earnings" shown below for the seven day reporting period which ended on the "Ending Date" shown below when the defendant in fact earned the "Actual Earnings" shown below from the employer named below. The defendants false statement and representation and failure to disclose a material fact were to obtain and increase a benefit under the Employment Security Law. County Of Residence Telephone No. Ending Date Race Sex Date Of Birth Age Reported Earnings $ Social Security No. Drivers License No. & State ORIGINAL Actual Earnings $ Name Of Defendants Current Employer Name And Address Of Employer Offense Code(s) Offense In Violation Of G.S. From Whom Actual Earnings Earned 96.18(a) 2663 Date Of Offense Date Of Arrest & Check Digit No. (As Shown On Fingerprint Card) Complainant (Name, Address Or Department) County Of Residence Telephone No. Names & Addresses Of Witnesses (Including Counties & Telephone Nos.) This act was in violation of the law referred to in this Warrant. This Warrant is issued upon information furnished under oath by the complainant listed. You are DIRECTED to arrest the defendant and bring the defendant before a judicial official without unnecessary delay to answer the charge above. Signature Location Of Court Date Issued Court Date Court Time Misdemeanor Offense Which Magistrate Deputy CSC AM Requires Fingerprinting Per Assistant CSC Clerk Of Superior Court PM AOC-CR-915M, Rev. 8/97 (Structured Sentencing) 1997 Administrative Office of the Courts ORIGINAL
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