IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT __________________ In the Matter of the Necessity for the Hospitalization of: Respondent. , ) ) ) ) ) ) Case No. NOTICE OF EXTENSION OF COMMITMENT PERIOD TO: Respondent Superior Court at Respondent's Attorney Respondent's Guardian Assistant Attorney General You are hereby given notice that the above-named respondent was absent without permission from the treatment facility from , 20____, _____ ___.m. to , 20 , _____ ___.m. During that time the respondent was not receiving treatment and for this reason, due to respondent's mental condition, he/she requires a continuation of treatment beyond the original time of commitment for a period of time equal to respondent's absence. Date Signature Print Name and Title I certify that on a copy of this notice was sent or given to: respondent court By Facility Personnel: I certify that on a copy of this notice was sent or given to: respondent's attorney respondent's guardian assistant attorney general Court Clerk: MC-435 (3/01)(cs) NOTICE OF EXTENSION OF COMMITMENT PERIOD AS 47.30.805(b) American LegalNet, Inc. www.FormsWorkFlow.com