MC-306 (8/18) REQUEST FOR TRANSPORT AND SERVICE, AND RETURN OF SERVICE IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Necessity ) for the Hospitalization of: ) ) ) Case No. , ) Respondent. ) Date of Birth: ) REQUEST FOR TRANSPORT AND ) SERVICE, AND RETURN OF SERVICE INSTRUCTIONS FOR LAW ENFORCEMENTpursuant to the Order Authorizing Hospitalization for Evaluation (Order) in this case. AS 47.30.870 provides that the Alaska Department of Health and Social Services will bear the costs, or reimburse the transporting agency for the costs, of this transport. The respondent shall also be given the notice of rights Gender Race Height Weight Hair Eyes ID/Driver's license # Address City Zip Physical characteristics (clothing, scars, other identifiable marks) Is there anyone else at the residence? No Yes If yes, relationship? Are there weapons at the residence? No Yes If yes, what kind? Is respondent taking any medication? No Yes If yes, what kind? Describe any history of violence Information provided by Telephone No. Contact person Telephone No. RETURN OF SERVICE I certify that on , State Trooper or Peace Officer named , picked up the respondent at this address: , and transported the respondent to Alaska Psychiatric Hospital . The documents listed above were served on (date) at Alaska Psychiatric Hospital , on (name) (title) . Comments: Return Date Printed Name Title American LegalNet, Inc. www.FormsWorkFlow.com