Send all correspondence to:
FILE NO.: _______________________
STATE OF NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE
COUNTY OF ________________ DISTRICT COURT DIVISION
STATE OF NORTH CAROLINA
vs. WAIVER OF APPEARANCE
________________________________,
Defendant
1. I have been issued a citation bearing the above referenced criminal file number(s).
2. After being fully appraised of my rights, I voluntarily and knowingly waive my right to testify in person at the District Court trial of this matter and further waive my right to face my accusers in person.
3. I further agree to be bound by the decision of the Court as in any other case of adjudication of guilt and entry of judgment, subject to the right of appeal in any other case.
4. Pursuant to the N.C.G.S. §15A-1011, I waive my appearance at the referenced trial and designate Bramble & Bramble, PA, Attorneys at Law, to determine what shall be in my best interests and to offer such pleas as they shall determine to be expedient and appropriate.
This the _____ day of _________, 20___.
_______________________________ Defendant’s Signature
******************************************************************************************************
Name: _______________________________________________________________________________________________
Mailing Address: ______________________________________________________________________________________
Street City State Zip Code
Telephone No(s). (Indicate Work, Cell, etc) ___________________________ Preferred method of contact: ______________
Email: ___________________________________________Last 4 digits of SSN.___________________________________
Date of Birth: ______________ Race: _____ Sex: ____ Driver’s License No. and State ____________________________
How many moving violation convictions (i.e., speeding, stop sign) have you had in last 3 years? _______________________
How many Improper Equipment convictions have you had in the last 3 years? ______________________________________
How many alcohol related traffic convictions (i.e., DWI, driving after consuming) have you had in the last 5 years? _____________________________________________________________________________________________________
Have you received a Prayer for Judgment (PJC) in the last 3 years? _______________________________________________
How many individuals are covered on your insurance policy other than yourself? ____________________________________
Has anyone other than you covered on your insurance policy received a PJC in the last 3 years? ________________________
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