New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter II - Cpl Section 330.20 Forms › Forms (cf. Part 110) › Form A-1 - Application and order to authorize confinement for additional period

Current through Register Vol. 46, No. 28, July
				  10, 2024
FORM A-1
APPLICATION AND ORDER TO
AUTHORIZE CONFINEMENT FOR
ADDITIONAL PERIOD
STATE OF NEW YORK
SUPREME COURT COUNTY COURT
PART: ________ COUNTY: ____________
________
PEOPLE OF THE STATE OF NEW YORK
vs. Indictment No. ____________
________
Defendant
________
(1) The undersigned is authorized by
				  the State Commissioner of Mental Health to submit this application for and on
				  behalf of the said Commissioner to the court pursuant to subdivision 4 of C PL
				  330.20 for an order authorizing temporary confinement of the above-named
				  defendant for an additional period of 30 days to complete the psychiatric
				  examination of the said defendant as directed by this court in a previously
				  issued examination order.
(2) This court issued an examination
				  order on [date] ________ directing that the above-named defendant submit to a
				  psychiatric examination to determine whether the said defendant has a dangerous
				  mental disorder, or if he she does not have a dangerous mental disorder,
				  whether the said defendant is mentally ill.
(3) The examination order referred to
				  in paragraph (2) of this application directed that the above-named defendant be
				  confined in a secure facility for a period not exceeding 30 days.
(4) Pursuant to the
				  examination order referred to in paragraph (2) of this application, the
				  above-named defendant is confined in the following secure facility of the State
				  Office of Mental Health: ____________
____________.
(5) The above-named defendant
				  was received at the secure facility referred to in paragraph (4) of this
				  application on [date] ________.
(6) The psychiatric examiners
				  designated by the Commissioner of Mental Health pursuant to the examination
				  order referred to in paragraph (2) of this application have commenced their
				  examination of the above-named defendant. The 30-day period referred to in the
				  said examination order expires on [date] ________.
(7) The undersigned is of the
				  view that the psychiatric examination of the above-named defendant will not be
				  completed prior to the expiration of the period referred to in paragraph (6) of
				  this application, and that a longer period will be necessary to complete the
				  aforesaid examination for the following reasons: ____________
____________
____________.
(8) Written notice of this
				  application has been given to the above-named defendant, counsel for the
				  defendant, the Mental Health Information Service and the District Attorney.
				  This written notice was given at least five (5) days prior to the date that
				  this application will be submitted to the court.
(9) No previous application
				  for the relief sought herein has been made.
WHEREFORE, the undersigned respectfully
					 requests that this application be granted and that the court issue an order
					 pursuant to subdivision 4 of C PL 330.20 authorizing confinement of the
					 above-named defendant in the aforesaid secure facility, pursuant to the
					 previously issued examination order, for an addition period of ________ (not
					 exceeding 30 days).
______________
Signature
______________
Type or Print Name
______________
Title
Date: ________
NOTICE OF APPLICATION
To:
1. Above-named defendant
2. Counsel for above-named
				  defendant
3. Mental
				  Health Information Service
4. District Attorney of ________
				  County