IN THE GENERAL SESSIONS CRIMINAL COURT SHELBY COUNTY, TENNESSEE DIVISION ________________ _________________________________________________________________________________________ STATE OF TENNESSEE VS. CASE NUMBER __________________________________ CHARGE (S) _____________________________________ ________________________________________________ _________________________________ DEFENDANT ________________________________________________________________________________________________________ ORDER DIRECTING EVALUATION OF DEFENDANT TO DETERMINE COMPETENCY TO STAND TRIAL PURSUANT TO T.C.A. 33-7-301 (A) ________________________________________________________________________________________________________ This cause came on to be heard this date before the undersigned Judge upon petition of ___________________________________, evaluation of the above named defendant, to determine competency to stand trial. IT IS, THEREFORE, ORDERED, ADJUDGED AND DECREED: 1. That the Sheriff of Shelby County, Tennessee, shall forthwith arrange for an examination of the defendant on the _______________day of ______________yr ________ at Midtown Mental Health Center: 2. 3. That a copy of this order shall be presented to the examiner at or before the time of evaluation: That Midtown Mental Health Center shall examine the defendant and determine: a) whether the defendant understands the nature of the legal process; b) whether the defendant understands the charges now pending in this cause; c) whether the defendant recognizes the possible consequences of said charges; d) whether the defendant is capable of assisting counsel and participating in the defense; 4. That Midtown Mental Health Center shall file with this Court a written report concerning the evaluation of the defendant on or before the __________day of ______________, yr_______. ENTER this the __________________day of ________________________ yr_________. ______________________________________________ JUDGE, GENERAL SESSIONS CRIMINAL COURT APPROVED: _________________________________ ATTORNEY FOR PROSECUTION _________________________________ ATTORNEY FOR THE DEFENDANT __________________________________ B.P.R. NUMBER American LegalNet, Inc. www.USCourtForms.com