Wisconsin > Statewide > Circuit Court > Medical
Affidavit Of Noncompliance With Settlement Agreement And Court Order ME-909 - Wisconsin
| Affidavit Of Noncompliance With Settlement Agreement And Court Order Form. This is a Wisconsin form and can be used in Medical Circuit Court Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. Calendar No. FORM SUMMARY Name of Form: : Statement of Noncompliance with Settlement Agreement and : JUDICIAL SUBPOENA Court OrderPlaintiff(s) -against: : Form Number: Statutory Reference: Benchbook Reference: Purpose of Form: ME-909 §51.20(8)(bm), Wisconsin Statutes : Defendant(s) MH 4-5 : ...................................................... If the subject of a settlement agreement does not comply with the treatment according to the agreement, the corporation counsel may file a statement to THE PEOPLE OF THE STATE OF NEW YORK reinitiate the commitment proceedings. This statement may be used by the corporation counsel for that purpose and to request detention of the subject pending the hearing. The TO order schedules the matter and directs whether the subject is to be ordered detained. Corporation counsel completes the sworn statement portion; the court completes the order portion WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before at the Court , GREETINGS: Who Completes It: the Honorable Distribution of Form: County of Original to court, copies to corporation counsel, subject, subject's located at counsel, county department at and the in room , on the day of , 20 , monitoring the agreement, noon, and at any recessed o'clock in the treatment facility or provider. or adjourned date, to testify and give evidence as a witness in this action on the part of the Generally none, unless additional documentation has been attached to this statement. Accompanying Forms: 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 New Form/Modification: Modification; last update 06/00. result of your failure to comply. Modifications: Witness, Honorable In #3 of the order, added provision for courtoneauthorize conditional , to of the Justices of the outpatient treatment pending hearing. Also included option that Court in County, day of , 20 transportation may be provided by other than sheriff. Also modified title to comply with statutory language. Comments: About this Form: None. (Attorney must sign above and type name below) This form is the product of the Wisconsin Records Management Committee, a committee of theAttorney(s) for Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the Office separate page. meaning of the form, attach it on a and P.O. Address The form itself shall not be altered. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Date: 12/16/02 Page 1 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : STATE OF WISCONSIN, CIRCUIT COURT, IN THE MATTER OF THE CONDITION OF Index No. COUNTY For Official Use : Statement of Noncompliance with Settlement Agreement SUBPOENA : JUDICIAL Plaintiff(s) and Court Order : Case No. Calendar No. Name of Subject -against- Date of Birth : Under oath I state that: : 1. A Settlement Agreement approved by the court is still in effect. 2. Upon information and belief, the subject has failed to comply with the Settlement Agreement as follows: Defendant(s) : ...................................................... THE the court: I request that PEOPLE OF THE STATE OF NEW YORK 1. Schedule a hearing as follows: TO a. Probable Cause Hearing (within 72 hours of detention if detained or within a reasonable time if not). b. Final hearing (within 14 days of detention if detained or 30 days if not detained). 2. Order the detention of the subject at pending further disposition. Name of Detention Facility Subscribed and sworn to before me GREETINGS: on Signature Corporation Counsel WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Name Printed or Typed Telephone Number Notary , the Honorable Public, State of Wisconsin at the Court My commission expires: located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed orthe above swornto testify and give evidence as a witness in this action on the part of the adjourned date, statement, THE COURT ORDERS: Based on 1. The subject shall appear at a Probable Cause Hearing Final Hearing held as follows: a. Date: Time: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Location: the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a b. At a date and comply. result of your failure to time to be determined after the subject has been taken into custody and detained. 2. The subject shall be served with this Statement and Order (and any attached papers). Witness, Honorable , one of the Justices of the 3. Pending the hearing, the subject shall be: Court in Detained at: County, day of , 20 a. Transportation to and from the court and the detention facility shall be provided by: The sheriff Other: b. Released under the following conditions: If the subject fails to comply with the conditions, the subject shall be detained at . . (Attorney must sign above and type name below) Attorney(s) for If you need help in matter because of a disability, please call: BY THE COURT: Office and P.O. Address Commissioner Circuit Court Judge/Circuit Court Distribution: 1. Court Original 2. Subject 3. Subject's Counsel 4. Corporation Counsel 5. County Dept. Monitoring Agreement 6. Treatment Facility/Provider 7. Detention Facility (if different) Name Printed or Typed ME-909, 12/02 Statement of Noncompliance with Settlement Agreement and Court Order This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.USCourtForms.com Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Date §51.20(8)(bm), Wisconsin Statutes
|
|||||||
