North Carolina In The General Court of Justice

                                                                                               District Court Division

State of North Carolina

v.                                                        Personal Appearance Waiver

Name

Now Comes the Defendant, pursuant to N.C.G.S. 15A-1011(a)(3), and waives the right to appear personally

for entry of plea and trial.  The Defendant authorizes Attorney David W. Rogers, to enter plea negotiations

and entry of plea  regarding this case.  The Defendant agrees to be bound by the Judgment

of the Court as in any other case of adjudication of guilty and entry of judgment, subject to the right of

appeal unless such right is waived.

Sign Here:                                           Court Date:

Mail To: Rogers Law Office

P.O. Box 469

Rutherfordton, NC 28139

RETURN TO: DAVID ROGERS LAW