IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Necessity for the Hospitalization of: ) ) ) ) ) Case No. ) ) NOTICE OF RELEASE OF ) RESPONDENT AND REQUEST ) FOR DISMISSAL OF PETITION am pm for an order authorizing , Respondent. Date of Birth: A petition was filed on at hospitalization for evaluation of the respondent named above pursuant to AS 47.30.700 et seq. I have not yet received notice that the court acted on the petition. The petition was granted by the court on but the respondent has not yet been transported to the designated evaluation facility. Having had further opportunity to observe the respondent, in my opinion as a mental health professional, I believe the respondent no longer meets the statutory criteria for hospitalization under AS 47.30.700. Therefore, I am providing the court with notice of the release of the respondent on dismissal of the petition. Date I certify that on a copy of this notice was sent or given to: Respondent Parent/Guardian PDA By: AGO at am pm, and requesting Signature Print Name Facility Email: Phone: ORDER Fax: IT IS SO ORDERED. The petition is dismissed. If an Order Authorizing Hospitalization for Evaluation was entered in this case, it is hereby vacated. Date I certify that on a copy of this order was sent or given to: Respondent Parent/Guardian PDA AGO By: Superior Court Judge Print Name MC-412 (2/17)(cs) NOTICE OF RELEASE OF RESPONDENT AND REQUEST FOR DISMISSAL OF PETITION American LegalNet, Inc. www.FormsWorkFlow.com