Wisconsin > Statewide > Circuit Court > Medical
Petition For Examination ME-903 - Wisconsin
| Petition For Examination Form. This is a Wisconsin form and can be used in Medical Circuit Court Statewide . |
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COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. FORM SUMMARY : : Index No. Calendar No. Name of Form: Form Number: Statutory Reference: Benchbook Reference: Petition for Examination Plaintiff(s) : : : : JUDICIAL SUBPOENA ME-903 -against§51.20, Wisconsin Statutes MH 1-9 Defendant(s) : Purpose .of. Form: . . . . . . . . . .This. form .initiates. involuntary.civil commitment proceedings by 3 ...... . ...... ... .... ...... .......... .. adult petitioners of an individual who is believed to be mentally ill, developmentally disabled, or drug dependent, and dangerous to self or to others. THE PEOPLE OF THE STATE OF NEW YORK TO Who Completes It: This form must be completed by the county corporation counsel, and must be sworn to be true and signed by 3 adult persons, at least one of whom has personal knowledge of the conduct of the subject individual. GREETINGS: Distribution of Form: The original document must be filed by the corporation counsel WE COMMAND YOU, that all business and for the countylaid aside, you and each is you attend before with the probate court excuses being where the individual of , the Honorable at of Court present or the county the the individual's legal residence. A copy located at County of must be provided to the subject individual at the time he or she is in room , on the day into , 20 , at o'clock in facility.noon, and at any recessed taken of custody for detention at a treatment the A second or adjourned date, to testify and givemust be provided to thethis action on the part of the evidence as a witness in detention facility at the time of copy admission of the individual. Accompanyingfailure to comply with this subpoena is punishable as a contempt of court and will make you liable to Your Forms: 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. New Form/Modification: Modification, last update 06/00. Witness, Honorable Minor reformatting. Modification: Court in County, day of , 20 , one of the Justices of the Comments: About this form: None This form is the product of the (Attorney must sign above and type name below) Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Office and P.O. Address Attorney(s) for Date: 12/16/02 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com STATE OF WISCONSIN, CIRCUIT COURT, IN THE MATTER OF THE CONDITION OF COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. COUNTY For Official Use Plaintiff(s) Name of Subject Calendar No. Petition for Examination : : : JUDICIAL SUBPOENA -againstDate of Birth Case No. Under oath, we petition the court to examine the condition of the subject, who resides in : at County , Defendant(s) : ...................................................... a. The subject is mentally ill, drug dependent, or developmentally disabled and a proper subject for treatment because: Address , and allege that: THE PEOPLE OF THE STATE OF NEW YORK TO See attached. GREETINGS: b. The subject is dangerous to himself/herself or others because: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the See attached. c. The following petitioner(s) has personal knowledge of theis punishable assubject: Your failure to comply with this subpoena conduct of the a contempt of court and will make you liable to Name 1) 2) 3) 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. Witness, Honorable Court in County, , one of the Justices of the day of , 20 Address Telephone Relationship to Subject d. The following petitioner(s) does not have personal knowledge of the conduct of the subject but bases his/her (Attorney must sign above and type name below) belief on the following: Name Address Telephone Relationship to Subject 1) Basis for Belief: Attorney(s) for 2) Basis for Belief: Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: ME-903, 12/02 Petition for Examination Mobile Tel. No.: This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 §51.20, Wisconsin Statutes American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Petition for Examination Page 2 of 2 : Name Address Index No. Case No. Calendar No. Telephone JUDICIAL SUBPOENA e. In addition to the petitioners, the following person(s) may testify in support of this petition: Plaintiff(s) : : : : -against- Defendant(s) : ...................................................... f. The names and post office address of subject's: (If unknown or inapplicable, so state.) Spouse Post Office Address THE PEOPLE OF THE STATE OF NEW YORK Adult Children TO Post Office Address GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court Parents or Guardian Post Office Address located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Custodian Post Office Address 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 Post Office Addressmaximum penalty of $50 and all damages sustained as a was issued for a Brothers/Sisters result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 Person(s) With Whom Subject Resides Post Office Address (Attorney must sign above and type name below) Attorney(s) for Signature of Petitioner Subscribed and sworn to before me on Notary Public/Court Official, State of Wisconsin Name Printed or Type
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