MC-505 (8/18)(cs) REQUEST TO DISMISS 72 HOUR HOSPITALIZATION PROCEEDINGS IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Necessity ) for the Hospitalization of: ) ) ) Case No. , ) Respondent. ) REQUEST TO DISMISS 72 HOUR Date of Birth: ) HOSPITALIZATION PROCEEDINGS I am the: petitioner respondent other person . I request the proceedings be dismissed and this case be closed because: Date Signature I certify that on a copy of this request was sent or given to: Print Name and Title Respondent Parent/Guardian PDA AGO Phone Number By: ORDER This request is denied. This request is granted. The 72-Hour Hospitalization Proceedings are dismissed and this case is closed. If the respondent was delivered to the evaluation facility, the respondent is ordered released from the facility. The facility shall file an MC-410, Notice of Release. If an Order Authorizing Hospitalization for Evaluation was entered, it is hereby vacated. Date Superior Court Judge I certify that on a copy of this order was sent or given to: Type or Print Name Respondent Parent/Guardian PDA AGO Eval. Fac. By: Clerical Instructions: (1) If judge grants dismissal and a pick - up order was previously issued, immediately execute the MC - 307, Recall of Transport Order. (2) Close petition and case using code MC505 . American LegalNet, Inc. www.FormsWorkFlow.com