COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .. STATE. OF NORTH CAROLINA : County Index No. In The General Court Of Justice District Court Division : Plaintiff(s) Calendar No. : IN THE MATTER OF: Name And Address Of Respondent File No. ORDER TO APPEAR JUDICIAL SUBPOENA : AT SUPPLEMENTAL HEARING -against- FOR INVOLUNTARY COMMITMENT : G.S. 122C-274, -277, -290, -291 ORDER TO RESPONDENT NAMED ABOVE : You are now under a commitment order. Defendant(s) It . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . with: 1.. . . has .been. alleged .that you .have clearly. refused. to. comply . . . . the treatment prescribed for you under an outpatient commitment order. 2. It has been alleged that you intend to move to another county within the State of North Carolina and are in need of further treatment at your new residence. THE PEOPLE OF THE STATE OF NEW YORK 3. You have been committed as a substance abuser, and it has been alleged that you need to be held in a 24-hour facility for longer than forty-five (45) consecutive days. TO 4. You have been committed after being charged with a violent crime and were found not guilty by reason of insanity or incapable of proceeding. The physician now treating you has determined that you do not need further treatment, but you may not be released without a hearing. GREETINGS: 5. The physician now treating you at the inpatient facility where you are being held has determined that you meet the criteria for outpatient commitment. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before You have requested a hearing to determine whether you should be discharged. 6.the Honorable at the Court , located at County of You in room are ORDERED to ,appear before a district court judge at the date, time and location indicated and at any that hearing, on the day of , 20 , at o'clock in the noon, below. At recessed it will be determined whether your commitment will be continued or modified, or whether you will be discharged. or adjourned date, to testify and give evidence as a witness in this action on the part of the At the hearing you will be allowed to present evidence. You may hire an attorney to represent you. If you cannot afford to hire an attorney and have been committed as a substance abuser, an attorney will be appointed for you. If you have been committed to outpatient commitment, you may ask the judge to appoint an attorney for you. Based on the facts in the particular Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to case, the judge may appoint one for you. the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a of your failure to comply. Date Signature Time Of Hearing result Date Of Hearing AM PM Location of Hearing Witness, Honorable Court in County, Assistant CSC day of , one of the Justices of the Court Clerk Of Superior , 20 NOTE TO CLERK: In addition to service on the respondent, this ORDER must be mailed to the petitioner (unless the petitioner waived his/her right to notice), the designated treatment center or physician and the respondent's counsel, if any, by first-class mail at least seventy-two (72) hours before the hearing. (If respondent was committed as a substance abuser, counsel appointed at the initial hearing remains responsible for representation.) (Attorney must sign above and type name below) TO PETITIONER-ATTORNEY-TREATMENT CENTER This ORDER to the respondent is sent to you to give you notice of the hearing described above. Name And Address Of Attorney For Respondent Name And Address Of Petitioner Attorney(s) for Office and P.O. Address Name And Address Of Treatment Center Or Physician AOC-SP-205, Rev. 7/04 2004 Administrative Office of the Courts Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: (Over) American LegalNet, Inc. www.USCourtForms.com COURT NOTICE TO SHERIFF COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : This Notice must be served on the respondent personally at least seventy-two (72) hours before the hearing. Index No. RETURN OF SERVICE : Calendar No. I certify that this Order was received and served on the respondent as follows: Date Served Plaintiff(s) Time Served -against- AM : JUDICIAL SUBPOENA Name Of Respondent : PM By delivering to the respondent named above a copy of this Order. : Respondent WAS NOT served for the following reason: : Defendant(s) : ...................................................... Date Received Date Returned Signature Of Deputy Sheriff Making Return THE PEOPLE OF THE STATE OF NEW YORK Name Of Deputy Sheriff Making Return (Type Or Print) TO County Of Sheriff GREETINGS: CLERK'S CERTIFICATION OF SERVICE I certify that I WE COMMAND YOU, that all businessfollowing, whose names and addresses are shown on the front of have mailed a copy of this Order to the and excuses being laid aside, you and each of you attend before this the Honorable form: , at the Court located at County of petitioner in room center/physician , on the day of , 20 , at o'clock in the noon, and at any recessed treatment or adjourned date, to testify and give evidence as a witness in this action on the part of the respondent's attorney Signature Date Deputy CSC Assistant CSC Clerk Of Superior Court 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 AOC-SP-205, Side Two, Rev. 7/04 2004 Administrative Office of the Courts Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com