Missouri > Local Circuit Courts > 7th Circuit (Clay County) > Probate > Adults
Application For Temporary Detention And Evaluation 381-A - Missouri
| Application For Temporary Detention And Evaluation Form. This is a Missouri form and can be used in Adults Probate 7th Circuit (Clay County) Local Circuit Courts . |
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CIRCUIT COURT OF CLAY COUNTY, MISSOURI PROBATE DIVISION No. Matter of , respondent, a person alleged to be mentally disordered. APPLICATION FOR TEMPORARY DETENTION AND EVALUATION (Sections 475.355 and 632.305 RSMo.) The applicant herein states to the Court as follows: 1. That a petition has been filed to appoint a Guardian and Conservator for the respondent, , age , who resides at and is now at 2. That the applicant has reason to believe that the respondent is mentally disordered as defined by law and presents a likelihood of serious physical harm to h_____self or others, and thus is in need of temporary detention and evaluation pending a hearing on the petition. 3. The facts that support the applicants belief that the respondent is mentally disordered are: 4. The facts that support the applicants belief that the respondent presents a likelihood of serious physical harm are: Form 381-A Page 1 of 2 Revised 3/14/2003 <<<<<<<<<********>>>>>>>>>>>>> 2 WHEREFORE, the applicant requests the Court to order that the respondent be taken into custody and transported to for temporary detention and evaluation pending a hearing on the Application To Appoint A Guardian And Conservator. THE STATEMENTS AND REPRESENTATIONS IN THIS DOCUMENT ARE MADE UNDER OATH AND ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THEY ARE MADE SUBJECT TO THE PENALTIES OF MAKING A FALSE AFFIDAVIT OR DECLARATION. Applicant (Signature) Address: Telephone: Relationship to Respondent: Form 381-A Page 2 of 2 Revised 3/14/2003
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