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Petition For Judicial Admission PCM 224 - Michigan
|Petition For Judicial Admission Form. This is a Michigan form and can be used in Mental Health Statewide .||
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Approved, SCAO OSM CODE: PJA STATE OF MICHIGAN FILE NO. PROBATE COURT PETITION FOR JUDICIAL ADMISSION COUNTY CIRCUIT COURT - FAMILY DIVISION In the matter of Social Security Number: 1. I, , am interested in this matter and make this petition as Name (type or print) . State interest/relationship 2. The above named individual, born , is a resident of , Date County Michigan, and can be found at . Address City State Zip 3. The individual is a person with mental retardation and can be reasonably expected within the near future to intentionally or unintentionally seriously physically injure self or another person and has overtly acted in a manner substantially supportive of that expectation. 4. This allegation is based upon: a. My personal observation of the individual doing the following acts and saying the following things: (PLEASE SEE OTHER SIDE) Do not write below this line - For court use only PCM 224 (9/97) PETITION FOR JUDICIAL ADMISSION MCL 330.1516; MSA 14.800(516)<<<<<<<<<********>>>>>>>>>>>>> 25. b. Conduct and statements by the individual, which I have been informed others have seen or heard: by: Witness name Complete address Telephone no. by: Witness name Complete address Telephone no. 5. Persons interested in these proceedings are: NAME RELATIONSHIP ADDRESS TELEPHONE NO. 6. The individual will not comply with an order for examination because: .I REQUEST 7. The court order the individual to be examined at Center . 8. The court order a peace officer to take the individual into protective custody and transport him/her immediately to Center for examination. 9. The individual be determined by the court to be a person meeting the criteria for judicial admission. I declare that this petition has been examined by me and that its contents are true to the best of my information, knowledge, and belief. Signature of attorney Date Name (type or print) Bar no. Signature of petitioner Address Address City, state, zip Telephone no. City, state, zip Telephone no.