ME-901, 05/14 Statement of Emergency Detention by Law Enforcement Officer 24751.15(4) and (5), 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 Statement of Emergency Detention by Law Enforcement Officer Court Case No. Law Enforcement Agency No. File this statement with the court immediately and with the detention facility upon admission. A probable cause hearing must be held within 72 hours after the subject is taken into custody. (In Milwaukee County, file this statement with detention facility only.) Please print or type all information below. All blanks must be filled in. I am a law enforcement officer and have cause to believe that: which constitutes a substantial probability of physical harm to self or to others, or as otherwise set forth in 24751.15(1), Wisconsin Statutes. My belief is based on specific and recent dangerous acts, attempts, threats, omissions, and/or statements made by the subject as observed by me or reliably reported to me as stated below: Dangerous Behavior When: Where: Describe Behavior: See attached page Witnesses to the dangerous behavior: (including officers who observed behavior) Name of Witness Te lephone Mailing Address Relationship [Name] of the County department of community programs (24751.42(3), Wis. Stats.) board approves the need for this detention. The subject was taken into custody for the purposes of this emergency detention on [Date] at [Time] am. pm. The potential detention facility is . . City County State Zip Code Phone Number DISTRIBUTION: 1. Court Signature of Officer Department 2. 24751.15(2) Detention Facility 3. Subject with Notice of Rights Name Printed or Typed Telephone American LegalNet, Inc. www.FormsWorkFlow.com