Looking frail and weak, Joseph James DeAngelo, wearing an orange jumpsuit, sat chained to a wheelchair while the charges against him were read.
DeAngelo is facing two counts of murder, but is suspected of at least 10 more murders, at least 50 rapes and multiple home burglaries across the state from 1976 to 1986.
WATCH: Entire court hearing for DeAngelo
Two of those killed are Fresno natives Katie Maggiore and Brian Maggiore. The couple was gunned down in Sacramento while walking their dog.
Katie's two brothers, Keith and Kenneth Smith, attended the arraignment and say it was a moment they never thought they would see.
"It was very difficult and satisfying at the same time," said Kenneth. And his brother told Action News, "Hearing the judge read the charges, that is what got me because it is real now."
Sacramento County District Attorney Anne Marie Schubert has been working on this case for nearly 20 years. She says her office is currently reaching out to the other agencies to see if additional charges will be filed.
"We're working with our DA's from these various counties," Schubert said. "So we're all going to be getting together to figure out what is the next step to see how to proceed on this case."
Meantime, DeAngelo's public defender, Diane Howard, says it is too early to jump to any conclusions.
"We have the law that suggests that he is innocent until proven guilty, and that is what I was going to ask everybody to remember. Because I feel that he has already been tried in the press," Howard said.
DeAngelo was denied bail and is eligible for the death penalty. His next court hearing is scheduled for May 14.