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Petition For Judicial Admission Form. This is a Michigan form and can be use in Mental Health Statewide.
Tags: Petition For Judicial Admission, PCM 224, Michigan Statewide, Mental Health
en-USIn the matter of en-USFirst, middle, and last nameen-US en-USLast four digits of SSN 1. � I, en-USName (type or print)en-US , am interested in this matter and make this petition as � en-USState your interest/relationshipen-US . 2. � The individual named above, born en-USDateen-US , is a resident of en-USCountyen-US , � Michigan, and can be found at en-USAddress City State Zipen-US . 3. � The individual is a person with an intellectual disability and � en-US a. can be reasonably expected within the near future to intentionally or unintentionally seriously physically injure self or � another person and has overtly acted in a manner substantially supportive of that expectation. � en-US b. has been arrested and charged with an offense that was a result of the intellectual disability. 4. � This allegation is based upon: � a. � My personal observation of the individual doing the following acts and saying the following things: � en-US � en-US � en-US � en-US � en-US � en-US � en-US � en-US � en-US � en-US � en-US � en-US � en-US(PLEASE SEE OTHER SIDE)en-USXXX-XX- American LegalNet, Inc. www.FormsWorkFlow.com File No. 4. � b. � The following conduct and statements by the individual, which I have been informed others have seen or heard: � en-US � en-US � en-US � by en-USWitness name Complete address Telephone no. � en-US � en-US � en-US � by: en-USWitness name Complete address Telephone no. 5. � Persons interested in these proceedings are: � en-USNAMEen-USRELATIONSHIPen-USADDRESSen-USTELEPHONE NO. � 6. � The individual will not comply with an order for examination because en-US � en-US en-US .en-USI REQUEST 7. � The court order the individual to be examined at en-USFacilityen-US . � 8. � The court order a peace officer to take the individual into protective custody and transport him/her immediately to � en-USFacilityen-US for examination. 9. � The individual be determined by the court to be a person meeting the criteria for judicial admission for treatment. en-USI declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best ofen-USmy information, knowledge, and belief. en-USSignature of attorney � en-USDate en-USName (type or print) Bar no. � en-USSignature of petitioner en-USAddress � en-USAddress en-USCity, state, zip Telephone no. � en-USCity, state, zip Telephone no. American LegalNet, Inc. www.FormsWorkFlow.com