Application For Transportation Of Mentally Disordered Ward To Mental Health Facility
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Application For Transportation Of Mentally Disordered Ward To Mental Health Facility Form. This is a Missouri form and can be use in 7th Circuit (Clay County) Local Circuit Courts.
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Tags: Application For Transportation Of Mentally Disordered Ward To Mental Health Facility, 377-A, Missouri Local Circuit Courts, 7th Circuit (Clay County)
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
CIRCUIT COURT OF CLAY COUNTY, MISSOURI
:
JUDICIAL SUBPOENA
Plaintiff(s)
PROBATE DIVISION
-against:
No.
:
Matter of
, an incapacitated person.
:
Defendant(s)
:
APPLICATION FOR TRANSPORTATION OF MENTALLY DISORDERED WARD
......................................................
TO MENTAL HEALTH FACILITY
I,
,
THE PEOPLE OF THE STATE OF NEW YORK
guardian of the above-named incapacitated person, state to the Court that said Ward is
TO
mentally disordered and should be admitted to a mental health facility as indicated by the
following conduct:
GREETINGS:
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.
WHEREFORE, the Guardian herein requests that the Court order that the said
Ward,
Witness, Honorable
Court in
County,
day of
, 20
of Clay County, Missouri, and be transported to
, be one of the Justices ofby the Sheriff
, taken into custody the
an
(Attorney must sign above for the Ward’s
appropriate mental health facility where I will make applicationand type name below)
admission.
Attorney(s) for
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 FALSE AFFIDAVIT Address
Office and P.O. OR DECLARATION.
______________
Date
Form 377-A
Revised 3/14/2003
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile
Page 1 of 1 Tel. No.:
Guardian
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