New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter II - Cpl Section 330.20 Forms › Forms (cf. Part 110) › Form H - Application for first retention order and notice of application

Current through Register Vol. 46, No. 28, July
				  10, 2024
FORM H
APPLICATION FOR A FIRST RETENTION
ORDER AND NOTICE OF APPLICATION
STATE OF NEW YORK
SUPREME COURT COUNTY COURT
PART: ________ COUNTY: ____________
________
IN THE MATTER
of
An Application for a First
Retention Order Pursuant to
C PL 330.20 in Relation to
________
Defendant
________
(1) The undersigned is authorized by
				  the State Commissioner of Mental Health to submit this application for a first
				  retention order for and on behalf of the said Commissioner.
(2) This application for a
				  first retention order is being submitted to the following court: [check one and
				  print name and address of indicated court]
Court that issued the prior recommitment
					 order: ____________
____________
County Court of the county wherein the
					 facility in which the defendant is confined is located: ____________
____________
Term of the Supreme Court for the county
					 wherein the facility in which the defendant is confined is located:
					 ____________
____________
(3) This application for a
				  first retention order is made pursuant to subdivision 8 of C PL 330.20. If this
				  application is granted, the undersigned requests that the first retention order
				  issued by this court take effect at the expiration of the period referred to in
				  paragraph (8) of this application and that it authorize continued custody of
				  the above-named defendant by the Commissioner of Mental Health for a period not
				  to exceed one year.
(4) The above-named defendant is
				  currently in the custody of the State Commissioner of Mental Health and is
				  confined in a secure facility for care and treatment pursuant to a commitment
				  order issued under the provisions of subdivision 6 of C PL 330.20
a recommitment order issued under the
					 provisions of subdivision 14 of C PL 330.20
by the following court on the following
					 date:
[Name of court] ____________
[Date of order] ____________
(5) Prior to the
				  issuance of the recommitment order referred to in paragraph (4) of this
				  application, a transfer order and a release order were issued by the following
				  courts on the following dates:
[Name of court issuing transfer order]
					 ____________
[Name of Court issuing release order]
					 ____________
[Date of release order] ____________
(6) The court
				  referred to in paragraph (4) of this application found the above-named
				  defendant to have a dangerous mental disorder, as that term is defined in
				  paragraph (c) of subdivision 1 of C PL 330.20.
(7) Pursuant to the order
				  referred to in paragraph (4) of this application, the above-named defendant is
				  currently confined in the following secure facility of the State Office of
				  Mental Health: ____________
(8) The order referred to in paragraph
				  (4) of this application directed that the above-named defendant be confined in
				  a secure facility for care and treatment for six months from the date of the
				  said order. The period prescribed in the said order expires on:
				  ________
(9) This
				  application is made upon the ground that the undersigned is of the view that
				  the above-named defendant: [check one]
currently suffers from a dangerous mental
					 disorder as that term is defined in paragraph (c) of subdivision 1 of C PL
					 330.20 in that the defendant currently suffers from an affliction with a mental
					 disease or mental condition which is manifested by a disorder or disturbance in
					 behavior, feeling, thinking, or judgment to such an extent that the defendant
					 requires care, treatment and rehabilitation, and that because of such condition
					 the defendant currently constitutes a physical danger to himself or
					 others.
does not currently suffer from a dangerous
					 mental disorder, as that term is defined in paragraph (c) of subdivision 1 of C
					 PL 330.20, but the above-named defendant is mentally ill in that the defendant
					 currently suffers from a mental illness for which care and treatment as a
					 patient, in the inpatient services of a psychiatric center under the
					 jurisdiction of the State Office of Mental Health, is essential to such
					 defendant's welfare and that his judgment is so impaired that he is unable to
					 understand the need for such care and treatment.
(10) The annexed psychiatric
				  reports are made a part of this application for a first retention order and
				  support the opinion of the undersigned concerning the current mental condition
				  of the above-named defendant.
(11) Pursuant to the provisions of
				  subdivision 8 of C PL 330.20, this application is being made at least 30 days
				  prior to the expiration of the period referred to in paragraph (8) of this
				  application.
(12)
				  Written notice of this application for a first retention order 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 15 days prior to the date that this application will be submitted to the
				  court indicated in paragraph (2) of this application.
(13) No previous application
				  for a first retention order has been made to any court.
WHEREFORE, the undersigned respectfully
					 requests that this application be granted and that a first retention order
					 issue authorizing continued custody of the above-named defendant by the
					 Commissioner of Mental Health for a period not to exceed one year from the date
					 such retention order takes effect.
______________
Signature
______________
Type or Print Name
______________
Title
Date: ________
NOTICE OF APPLICATION FOR A FIRST RETENTION
					 ORDER
To:
1. Above-named defendant
2. Counsel for above-named
				  defendant
3. Mental
				  Health Information Service
4. District Attorney of ________ County
PLEASE TAKE NOTICE that the above
					 application for a first retention order will be submitted to the court
					 indicated in paragraph (2) of the application on: [date and time]
____________
____________
Upon receipt of the above application for a
					 first retention order, the court may, on its own motion, conduct a hearing to
					 determine whether the defendant has a dangerous mental disorder.
The court must conduct a hearing to
					 determine whether the defendant has a dangerous mental disorder if a timely
					 demand is made to the court by the defendant, counsel for the defendant, the
					 Mental Health Information Service or the District Attorney.
A demand for a hearing is timely if it is
					 made within 10 days from the date that this notice of application was given to
					 you.
You may make a demand for a hearing by
					 writing directly to the court indicated in paragraph (2) of the above
					 application.
Failure to demand a hearing will permit the
					 court to rule on the above application without a hearing.
SPECIAL NOTICE TO DEFENDANT:
You are hereby advised that the Mental
					 Health Information Service, which is an agency of the Supreme Court of the
					 State of New York, has been established to provide you with assistance and
					 information as to your rights under the law and the procedures governing your
					 retention. You are entitled to communicate with a representative of the Service
					 at any time.
The location and telephone number of the
					 Mental Health Information Service office serving your hospital appear
					 below.
You may communicate with the Mental Health
					 Information Service office directly, or you may request a member of the
					 hospital staff to inform the Service of your desire to see a representative. A
					 member of the Service will then see you in the hospital.
You have a right to a court hearing on the
					 above application if you make a timely demand for such hearing. You have a
					 right to be represented by counsel at such hearing and you have the right to
					 have counsel assigned by the court if you are financially unable to obtain your
					 own lawyer.
Mental Health Information Service
____________
____________
Telephone No. ____________