ME-911, 02/11 Order of Commitment/Extension of Commitment/Dismissal 24751.20(13), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE CONDITION OF Name of Subject Date of Birth Amended Order of Commitment Extension of Commitment Dismissal Case No. A hearing was held on [Date] . THE COURT FINDS: 1. Grounds for commitment extension of commitment have not been established. 2. Grounds for commitment extension of commitment have been established. The subject is A. mentally ill. drug dependent. developmentally disabled. B. dangerous because the subject evidences behavior within one or more of the standards under 24724751.20(1) or (1m), Wis. Stats. (except for proceedings under 24751.20(1)(a)2.e., Wis. Stats.). C. a proper subject for treatment. D. a resident of County, Wisconsin. a nonresident of the state of Wisconsin. an inmate of a Wisconsin state prison. 3. The dangerousness of the subject is likely to be controlled with appropriate medication administered on an outpatient basis. 4. The subject has been adjudicated pursuant to 18 USC 922(g)(4) mental institution. 5. Other: THE COURT ORDERS: 1. This matter is dismissed. 2. The subject is committed for months from the date of this hearing to the care and custody of the A. County Department established under 24724751.42 or 51.437, Wisconsin Statutes. B. Department of Health Services. American LegalNet, Inc. www.FormsWorkFlow.com ME-911, 02/11 Order of Commitment/Extension of Commitment/Dismissal 24751.20(13), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 3. The maximum level of treatment shall be A. a locked an unlocked inpatient facility. The reception facility shall be . Transportation to the facility shall be provided by the sheriff. Other: B. outpatient with conditions. The conditions of outpatient commitment on the attached document are incorporated into this order. A violation of any condition may result in the subject being taken into custody by law enforcement for inpatient treatment. 4. The subject is prohibited from possessing any firearm. Federal law provides penalties for, and you may be prohibited from possessing, transporting, shipping, receiving, or purchasing a firearm, including, but not limited to, a rifle, shotgun, pistol, revolver, or ammunition, pursuant to 18 U.S.C. 921(a)(3) and (4) and 922(g)(4). This prohibition shall remain in effect until lifted by the court. Expiration of the mental commitment proceeding does not terminate this restriction. A. Any firearm owned by subject shall be seized by . The subject . Any person residing at the/these locations is required to cooperate with law enforcement attempts to seize firearms. Failure to cooperate may result in contempt sanctions. B. As an alternative to seizure, the following person is designated to store any firearm(s) until the firearm restriction order has been canceled: . C. The subject is informed of the requirements and penalties under 247941.29, Wis. Stat. including imprisonment for up to 10 years, a fine not to exceed $25,000 or both. D. The court clerk shall notify the department of justice of the restriction unless the department has been previously informed of a prohibition for this subject. 5 . Other: THIS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL. DISTRIBUTION: 1. Court 2. Subject 3. Attorney 4. Treatment Provider 5. Detention facility (if different) American LegalNet, Inc. www.FormsWorkFlow.com