COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. STATE OF NORTH CAROLINA : File No. Index No. In The General Court Of Justice District Court Division : IN THE MATTER OF: Plaintiff(s) Name And Address Of Respondent -against- Calendar No. : County JUDICIAL SUBPOENA : NOTICE OF HEARING/REHEARING FOR INVOLUNTARY COMMITMENT : : Date Of Birth G.S. 122C-264, -274, -276, -284, -292 Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . .NOTICE. TO THE .RESPONDENT. NAMED ABOVE ...... ....... ............ .. (Check only one) inpatient 1. It has been alleged that you are mentally ill and a proper subject for involuntary commitment. outpatient THE PEOPLE OF THE STATE OF NEW YORK 2. It has been alleged that you are a substance abuser and a proper subject for involuntary commitment. TO 3. The physician now treating you has determined that you are in need of further care and treatment beyond your present period of commitment. 4. You have been committed after (a) being charged with a violent crime and being found incapable of proceeding or GREETINGS: (b) being found not guilty by reason of insanity. The physician now treating you has determined that further treatment is not necessary. However, you may not be released without the hearing referred to below. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before A hearing Honorable before a district court judge at the at the time and place indicated below. At that hearing it will be , date, the will be held Court determined if you should be committed,located at or recommitted for treatment. released, County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed At this hearing you will be allowed to present evidence. If the hearing is for inpatient commitment or for commitment as a or adjourned date, to testify and give evidence as a witness in this action on the part of the substance abuser, you have a right to be represented by an attorney. If you cannot afford an attorney, one will be appointed for you. If the hearing is for an outpatient commitment, you may hire an attorney to represent you. If you cannot afford an Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to attorney, you may ask the court to appoint one for you. However, the court may or may not appoint an attorney based thefacts in your particular case. party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a upon the result of your failure to comply. Place Of Hearing Date Of Hearing Witness, Honorable Time Of Hearing Court in County, , one of the Justices of the day of AM , 20 PM NOTICE TO SHERIFF (Attorney must sign above hearing. This Notice must be served on the respondent at least seventy-two (72) hours before the and type name below) Date Signature Deputy CSC Assistant CSC Clerk Of Superior Court Attorney(s) for Office and P.O. Address Original-File AOC-SP-301, Rev. 3/02 2002 Administrative Office of the Courts I Telephone No.: Facsimile No.: E-Mail Address: Copy-Petitioner Copy-Respondent Copy-Attorney Mobile Tel. No.: (Over) American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. RETURN OF SERVICE : Index No. I certify that this Notice was received and served on the respondent as follows: Name Of Respondent Time Served Date Served AM PM : Calendar No. 1. By delivering to the respondent named above a copy of this Notice. : JUDICIAL SUBPOENA Plaintiff(s) 2. By leaving a copy of this Notice at the respondent's dwelling house or usual place of abode with a person of suitable age and discretion then residing therein. -against: Name Of Person With Whom Copies Left : Address Where Copies Delivered Or Left : Service Accepted By Attorney For Respondent Defendant(s) : ...................................................... Signature Date Accepted Respondent WAS NOT served for the following reason: THE PEOPLE OF THE STATE OF NEW YORK Date Received TO Date Returned Name Of Sheriff Deputy Sheriff Making Return County GREETINGS: NOTE TO CLERK: (In Addition To Service On Respondent) For cases in which WEexaminer recommendsthat all business and excuses being laid mentally ill: and each of you attend before the COMMAND YOU, inpatient commitment for a person who is aside, you The clerk in the county where the 24-hour facility is located mustat the in the mail aCourtof this Notice by first-class mail at least deposit copy , the Honorable 72 hoursCountythe hearing to the respondent's counsel and the petitioner, unless the petitioner has waived his/her right to notice on before of located at form AOC-SP-300. If the respondent has been found not guilty by reason of insanity or has been charged with a violent crime and been in roomof proceeding, the clerk must also mail a copy of 20 notice to the chief district court judge and the district attorney , on the day of , the , at o'clock in the noon, and at any recessed found incapable or adjournedthe defendant was found not guilty byas a witness in this action on theproceeding. date, to testify and give evidence reason of insanity or incapable of part of the in the county in which For cases in which the examiner recommends outpatient commitment for a person who is mentally ill: The clerk in the county where the petition was initiated must deposit in the mail a copy of this Notice by first-class mail at least 72 hours before the hearing Your failure to outpatient treatment center or is punishable theapetitioner, unless the and will make you liable to to the proposed comply with this subpoena physician and as contempt of court petitioner has waived his/her right to notice. If the respondent was charged with a violent crime and found incapable of proceeding, see instructions immediately the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a above for additional persons to be served. result of your failure to comply. For cases in which the examiner finds that the respondent is a substance abuser: The clerk in the county whereHonorableis located if respondent is held in a 24-hour facility , one of thein the county the or the clerk Justices of where the petition Witness, the facility was initiated if not held in a 24-hour facility must deposit in the mail a copy of this Notice by first-class mail at least 72 hours before the Court in County, day of , 20 hearing to the respondent's counsel and the petitioner, unless the petitioner has waived his/her right to notice. Notice should also be sent to the area authority or physician that will be responsible for the commitment. CLERK'S CERTIFICATION OF SERVICE I certify that I have mailed copies of this Notice by first class mail at least 72 hours before the type name to the persons (Attorney must sign above and hearing below) whose name and address are listed below (fill in only those appropriate): Name And Address Of Petitioner Name And Address Of Counsel For Respondent Attorney(s) for Name And Address Of Proposed Outpatient Treatment Center/Physician Name And Address Of Area Authority/Physician Office and P.O. Address Date Signature AOC-SP-301, Side Two, Rev. 3/02 2002 Administrative Office of the Courts Telephone No.: Facsimile No.: Deputy CSC E-Mail Address: Mobile Tel. No.: Assistant CSC Clerk Of Superior Court American LegalNet, Inc. www.USCourtForms.com