Date: _____________________ County: ____________________ Administrative Sheriff In Charge: ______________________________________ MENTAL HYGIENE WARRANTS INTAKE SHEET Petitioner’s Name: _______________________________________________________ Petitioner’s Address: _____________________________________________________ Petitioner’s Telephone #: __________________________________________________ Name of Person to be Detained: ____________________________________________ Your Relationship To The Person: ___________________________________________ Where Can The Person Be Found: __________________________________________ Person’s Description: Sex__ Height ____Weight ___ Age___ Photo Provided? Y __N__ Behavior of Person: (i.e., violent, argumentative, reclusive, other): _________________ ______________________________________________________________________ Petitioner’s Signature: ___________________________ Date:___________________ OFFICIAL USE ONLY Priority in Execution: 1) Immediately Note Special Circumstances __________________________________ 2) Normal __________________________________ 3) Other _____________________ __________________________________ Scheduled Date of Execution: _____________________________ NYPD Precinct: _____________________ Phone #: ___________________ Deputies Assigned: _____________________________________________________ Warrant & Sheet Reviewed By: __________________________________________ Approved: ______________ Rejected: _____________ American LegalNet, Inc. www.USCourtForms.com