COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : CIRCUIT COURT OF CLAY COUNTY, MISSOURI JUDICIAL SUBPOENA Plaintiff(s) PROBATE DIVISION -against: No. : : Matter of mentally disordered. , respondent, a person alleged to be Defendant(s) : ...................................................... APPLICATION FOR TEMPORARY DETENTION AND EVALUATION (Sections 475.355 and 632.305 RSMo.) THE PEOPLE OF THE STATE OF NEW YORK TO The applicant herein states to the Court as follows: GREETINGS: 1. That a petition has been filed to appoint a Guardian and Conservator for the respondent, , age resides at now at , who and is WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court 2. That the applicant has reason to believe that the respondent is mentally disordered as located at County of defined by day of presents, a likelihood of serious physical harm to h_____self or others, law and in room , on the 20 , at o'clock in the noon, and at any recessed and thus isgiveneed of temporary detention and evaluation pending a hearing on the in evidence as a witness in this action on the part of the or adjourned date, to testify and petition. 3. The facts that support the applicant’s belief that the respondent is mentally disordered Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to are: the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 4. The facts that support the applicant’s(Attorneythat the respondent presents a likelihood of belief must sign above and type name below) serious physical harm are: Attorney(s) for Office and P.O. Address Form 381-A Revised 3/14/2003 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : Index No. Calendar No. WHEREFORE, the applicant requests the Court to order that the respondent be taken : JUDICIAL SUBPOENA Plaintiff(s) into custody and transported to -againstfor temporary detention and : evaluation pending a hearing on the Application To Appoint A Guardian And Conservator. : THE STATEMENTS AND REPRESENTATIONS IN THIS DOCUMENT ARE MADE UNDER OATH AND ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND : BELIEF. I UNDERSTAND THEY ARE MADE SUBJECT TO THE PENALTIES OF MAKING A Defendant(s) FALSE AFFIDAVIT OR DECLARATION. : ...................................................... Applicant THE PEOPLE OF THE STATE OF NEW YORK (Signature) Address: TO Telephone: GREETINGS: Relationship to Respondent: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Court in Witness, Honorable County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Form 381-A Revised 3/14/2003 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com