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Petition And Custody Order For Special Emergency Substance Abuse Involuntary Commitment SP-909M - North Carolina
| Petition And Custody Order For Special Emergency Substance Abuse Involuntary Commitment Form. This is a North Carolina form and can be used in Special Proceedings Statewide . |
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File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Court Division IN THE MATTER OF: PETITION AND CUSTODY ORDER Name And Address Of Respondent (Including Zip Code) FOR SPECIAL EMERGENCY SUBSTANCE ABUSE INVOLUNTARY COMMITMENT Date Of Birth Of Respondent G.S. 122C-282 I, the undersigned affiant, being first duly sworn, and having sufficient knowledge to believe that the respondent is a proper subject for involuntary commitment, allege that the respondent is a resident of, or can be found in the above named county, and is a substance abuser who is dangerous to himself or others. I have taken the respondent into custody and brought the respondent immediately before the Court because he/she is violent and requires restraint and the delay which would result from obtaining a medical examination would endanger life or property. The facts upon which this opinion is based are as follows: Name And Address Of Nearest Relative Or Guardian (Including Zip Code) Name And Address Of Other Person Who May Testify To Facts (Including Zip Code)Home Telephone No. Business Telephone No. Home Telephone No. Business Telephone No. I request the Court to authorize the transportation of the respondent to a 24-hour facility for temporary custody, observation and treatment pending a district court hearing. Signature Of Petitioner-Officer SWORN AND SUBSCRIBED TO BEFORE ME Date Name And Address Of Petitioner-Officer (Including Zip Code) (Type Or Print)Signature Deputy CSC Assistant CSC Clerk Of Superior Court Magistrate AOC-SP-909M, Rev. 7/98 Original-File Copy-hospital Copy-Special Counsel Copy- ttorney General 1998 Administrative Office of the Courts (Over) <<<<<<<<<********>>>>>>>>>>>>> 2 FINDINGS The Court finds that there are reasonable grounds to believe that the facts alleged in the petition are true and that the respondent is probably a substance abuser and dangerous to himself or others. The Court further finds by clear, cogent, and convincing evidence that the respondent is in fact violent and requires restraint, and delay in taking the respondent to a physician or eligible psychologist for examination would endanger life or property. CUSTODY ORDER TO ANY LAW ENFORCEMENT OFFICER The Court orders you to take the named respondent into custody and transport the respondent directly to the 24-hour facility named below, for temporary custody, examination and treatment pending a district court hearing. Name And Address of 24-Hour Facility For Substance Abuser Date Time AM PM Signature Deputy CSC Assistant CSC Clerk Of Superior Court Magistrate RETURN OF SERVICE The respondent WAS NOT taken into custody for the following reason: I certify that this Order was received and served as follows: Date Respondent Taken Into Custody Time AM PM I transported the respondent directly to and placed him in the temporary custody of the facility named below. Name Of 24-Hour Facility For Substance Abuser Date Order Received Date Of Return Date Delivered Signature Of Law Enforcement Officer Time Name Of Transporting Agency AM PM PETITIONERS WAIVER OF NOTICE OF HEARING I voluntarily waive my right to notice of all hearings and rehearings in which the Court may commit the respondent or extend the respondents commitment period, or discharge the respondent from the treatment facility. Signature Of Witness Date Signature Of Petitioner-Officer AOC-SP-909M, Side Two, Rev. 7/98 1998 Administrative Office of the Courts
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