3-20 Petition (to extend period of commitment)  

   

 

________________

 

   

______ Respondent.

________________

TO THE FAMILY COURT:

The undersigned Petitioner respectfully alleges that:

1. Petitioner is the (designee of the) (Commissioner of Mental Health) (Commissioner of Mental Retardation and Developmental Disabilities).

2. Pursuant to an order of this Court dated __, 19 , the above-named Respondent was committed to the custody of (Commissioner of Mental Health) (Commissioner of Mental Retardation and Developmental Disabilities) for a period of __, which will expire on __, 19.

3. This application is being made not more than 60 days prior to the expiration date of the above-mentioned order.

  

WHEREFORE, Petitioner prays that the Order dated __, 19 , be amended to extend the period of commitment until __, 19.

Dated: ______, 19.

(Commissioner) (designee)

By Name

Title

   

__, being duly sworn, deposes and says:

That (s)he is the __ of __, an agency authorized to originate the above-entitled proceeding, and is acquainted with the facts and circumstances therein; that (s)he has read the foregoing and knows the contents thereof; that the same is true to (his) (her) own knowledge, except as to matters therein stated to be alleged on information and belief and as to those matters (s)he believes it to be true.

Name

Title

 

(Notary Public)