Petition For Judicial Admission {PCM 224}

en-USIn the matter of en-USFirst, middle, and last nameen-US en-USLast four digits of SSN 1. þ I, en-USName (type or print)en-US , am interested in this matter and make this petition as þ en-USState your interest/relationshipen-US . 2. þ The individual named above, born en-USDateen-US , is a resident of en-USCountyen-US , þ Michigan, and can be found at en-USAddress City State Zipen-US . 3. þ The individual is a person with an intellectual disability and þ en-US a. can be reasonably expected within the near future to intentionally or unintentionally seriously physically injure self or þ another person and has overtly acted in a manner substantially supportive of that expectation. þ en-US b. has been arrested and charged with an offense that was a result of the intellectual disability. 4. þ This allegation is based upon: þ a. þ My personal observation of the individual doing the following acts and saying the following things: þ en-US þ en-US þ en-US þ en-US þ en-US þ en-US þ en-US þ en-US þ en-US þ en-US þ en-US þ en-US þ en-US(PLEASE SEE OTHER SIDE)en-USXXX-XX- American LegalNet, Inc. www.FormsWorkFlow.com File No. 4. þ b. þ The following conduct and statements by the individual, which I have been informed others have seen or heard: þ en-US þ en-US þ en-US þ by en-USWitness name Complete address Telephone no. þ en-US þ en-US þ en-US þ by: en-USWitness name Complete address Telephone no. 5. þ Persons interested in these proceedings are: þ en-USNAMEen-USRELATIONSHIPen-USADDRESSen-USTELEPHONE NO. þ 6. þ The individual will not comply with an order for examination because en-US þ en-US en-US .en-USI REQUEST 7. þ The court order the individual to be examined at en-USFacilityen-US . þ 8. þ The court order a peace officer to take the individual into protective custody and transport him/her immediately to þ en-USFacilityen-US for examination. 9. þ The individual be determined by the court to be a person meeting the criteria for judicial admission for treatment. en-USI declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best ofen-USmy information, knowledge, and belief. en-USSignature of attorney þ en-USDate en-USName (type or print) Bar no. þ en-USSignature of petitioner en-USAddress þ en-USAddress en-USCity, state, zip Telephone no. þ en-USCity, state, zip Telephone no. American LegalNet, Inc. www.FormsWorkFlow.com