Missouri > Local Circuit Courts > 7th Circuit (Clay County) > Probate > Adults
Application For Transportation Of Mentally Disordered Ward To Mental Health Facility 377-A - Missouri
| Application For Transportation Of Mentally Disordered Ward To Mental Health Facility 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 , an incapacitated person. APPLICATION FOR TRANSPORTATION OF MENTALLY DISORDERED WARD TO MENTAL HEALTH FACILITY I, , guardian of the above-named incapacitated person, state to the Court that said Ward is mentally disordered and should be admitted to a mental health facility as indicated by the following conduct: WHEREFORE, the Guardian herein requests that the Court order that the said Ward, , be taken into custody by the Sheriff of Clay County, Missouri, and be transported to an appropriate mental health facility where I will make application for the Wards admission. 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. ______________ Date Guardian Form 377-A Page 1 of 1 Revised 3/14/2003
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