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

Current through Register Vol. 46, No. 28, July
				  10, 2024
FORM S
APPLICATION FOR A RECOMMITMENT
ORDER AND NOTICE OF APPLICATION
STATE OF NEW YORK
SUPREME COURT COUNTY COURT
PART: ________ COUNTY: ____________
________
IN THE MATTER
of
An Application for a Recommitment
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 recommitment order for and on
					 behalf of the said Commissioner.
(1) The undersigned is authorized by the District Attorney
					 of ________County to submit this application for a recommitment order for and
					 on behalf of the said District Attorney.
(2) The application for a recommitment order is being
					 submitted to the following court: [check one and print name and address of
					 indicated court]
Court that issued the existing order of
					 conditions ____________
____________
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 recommitment order is made
					 pursuant to subdivision 14 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 by the following court on the
					 following date:
[Name of court] ____________
[Date of order] ____________
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 issuance of 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
					 on the following date:
[Name of court] ____________
[Date of release order] ____________
(10) At the time of the issuance of the release order
					 referred to in paragraph (9) of this application, the court that issued the
					 said release order also issued, in accordance with the provisions of
					 subdivision 12 of C PL 330.20, an order of conditions. The period prescribed in
					 the said order of conditions expires on ________. This application for a
					 recommitment order is made during the period covered by the said order of
					 conditions.
(11) This application is made upon the ground that the
					 undersigned is of the view that the above-named defendant has a dangerous
					 mental disorder, 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.
(12) The annexed report is made a part of this application
					 for a recommitment order and supports the view stated by the undersigned in
					 paragraph (11) of this application.
(13) Written notice of this application for a recommitment
					 order has been given to the above-named defendant, counsel for the defendant,
					 the Mental Health Information Service and the District Attorney and the State
					 Commissioner of Mental Health. This written notice was given at least 10 days
					 prior to the date that this application will be submitted to the court
					 indicated in paragraph (2) of this application.
(14) No previous application for a
					 recommitment order has been made to any court.
WHEREFORE, the undersigned respectfully
					 requests that this application be granted and that a recommitment order issue
					 committing the above-named defendant to the custody of the State Commissioner
					 of Mental Health for confinement in a secure facility for care and treatment
					 for six months from the date of the order.
______________
Signature
______________
Type or Print Name
______________
Title
Date: ________
NOTICE OF APPLICATION FOR A RECOMMITMENT
					 ORDER
To:
1. Above-named defendant
2. Counsel for above-named defendant
3. Mental Health Information Service
4. District Attorney of ________ County
5. State Commissioner of Mental Health
PLEASE TAKE NOTICE that the above
					 application for a recommitment order will be submitted to the court indicated
					 in paragraph (2) of the application on: [date and time]
____________
____________
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
					 commitment. 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 have a right to a court hearing on the
					 above application for a recommitment order. 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. ____________