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

Current through Register Vol. 46, No. 28, July
				  10, 2024
FORM W
APPLICATION FOR A DISCHARGE ORDER
AND NOTICE OF APPLICATION
STATE OF NEW YORK
SUPREME COURT COUNTY COURT
PART: ________ COUNTY: ____________
________
IN THE MATTER
of
An Application for a Discharge 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
				  discharge order for and on behalf of the said Commissioner.
(2) This application for a
				  discharge order is being submitted to the following court: [check one and print
				  name and address of indicated court]
Court that issued the release order
					 ____________
County Court of the county wherein the
					 defendant is now residing ____________
____________
Term of the Supreme Court for the county
					 wherein the defendant is now residing ________________________
(3) This
				  application for a discharge order is made pursuant to subdivision 13 of C PL
				  330.20.
(4) The
				  above-named defendant was committed to the custody of the State Commissioner of
				  Mental Health for confinement 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) Subsequent to
				  this issuance of the order referred to in paragraph (4) of this application,
				  the following court issued a first retention order on the following date:
[Name of court] ____________
[Date of first retention order]
					 ____________
(6) Subsequent to the issuance of the
				  first retention order referred to in paragraph (5) of this application, the
				  following court issued a second retention order on the following date:
[Name of court] ____________
[Date of second retention order]
					 ____________
(7) Following the issuance of the
				  second retention order referred to in paragraph (6) of this application, the
				  following court issued a subsequent retention order on the following date:
[Name of court] ____________
[Date of each subsequent retention order,
					 including last subsequent retention order] ____________
(8) Subsequent to the order
				  referred to in paragraph (4) of this application, the following court issued a
				  transfer order on the following date:
[Name of court] ____________
[Date of transfer order] ____________
(9) Subsequent to
				  the issuance of the order referred to in paragraph (4) of this application, the
				  following court issued a release order and an order of conditions on the
				  following date:
[Name of court] ____________
[Date of release order and order of
					 conditions] ____________
(10) The above-named defendant has been
				  continuously on an outpatient status for three years or more pursuant to the
				  release order and order of conditions referred to in paragraph (9) of this
				  application.
(11)
				  This application is made upon the ground that the undersigned is of the view
				  that the above-named defendant no longer has a dangerous mental disorder and is
				  no longer mentally ill and that the issuance of a discharge order is consistent
				  with the public safety and welfare of the community and the
				  defendant.
(12) The
				  reasons for the view stated by the undersigned in paragraph (11) of this
				  application are as follows:
____________
____________
____________
____________
____________
WHEREFORE, the undersigned respectfully
					 requests that this application be granted and that a discharge order issue
					 terminating the order of conditions referred to in paragraph (9) of this
					 application. unconditionally discharging the above-named defendant from
					 supervision under the provisions of C PL 330.20.
______________
Signature
______________
Type or Print Name
______________
Title
NOTICE OF APPLICATION FOR A DISCHARGE
					 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 discharge order will be submitted to the court indicated in
					 paragraph (2) of the application on: [date and time]
____________
____________