STATE OF NORTH
CAROLINA
COUNTY OF
IN THE GENERAL COURT OF
JUSTICE
SUPERIOR COURT
DIVISION
FILE
NO.:
)
STATE OF NORTH CAROLINA
)
)
ACKNOWLEDEMENT OF
vs.
)
NON-ALTERATION
)
)
Defendant
)
)
I, Sara A. Lane, do hereby acknowledge the following:
This the _____ day of ______________________, 20_____.
___________________________________ ____________________________________
Signature
Witness