Nd Petition For Involuntary Commitment Form PDF Details

In the realm of mental health and substance abuse intervention, the legal process in North Dakota is embodied in the "Nd Petition For Involuntary Commitment" form, a crucial document for initiating the involuntary commitment of an individual who is believed to be a threat to themselves or others due to mental illness or chemical dependency. This form, officially recognized by the North Dakota Supreme Court as SFN 17260 (GN-1), serves a foundational role in the protective measures the state can take. It contains detailed sections that must be filled out meticulously, including personal information about the respondent, such as their name, address, age, sex, marital status, and occupation, as well as similar details for the petitioner and any relevant witnesses. The form also delineates the legal basis for the request, specifying whether the person in question is believed to be mentally ill or chemically dependent, and it lists the factors that lead the petitioner to believe an involuntary commitment is necessary. Crucially, it offers a space for the petitioner to indicate whether they believe the respondent requires immediate custody for emergency treatment, supported by descriptions of specific overt acts indicating imminent danger. This document therefore plays a pivotal role in ensuring the safety and well-being of not only the individual concerned but also the community at large, making its accurate completion and submission an essential step in the legal process for involuntary commitment in North Dakota.

QuestionAnswer
Form NameNd Petition For Involuntary Commitment Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesnd form 17260 petiton printable, north dakota commitment forms, civil commitment in north dakota, nominating petitions north dakota 2020

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PETITION FOR INVOLUNTARY COMMITMENT

NORTH DAKOTA SUPREME COURT

SFN 17260 (GN-1) (Rev. 03-2006)

STATE OF NORTH DAKOTA

County of

IN THE INTEREST OF

Name of Respondent::

Information about the respondent is as follow:

Address:

 

City:

 

State:

 

Zip Code:

 

 

 

 

 

 

 

Telephone:

 

 

 

 

 

 

 

 

 

 

 

 

 

The respondent's present whereabouts are as follow:

 

 

 

 

 

 

 

 

 

 

 

 

Age:

Date of birth:

Sex:

 

 

 

Marital Status:

 

 

G Male

G Female

 

 

 

 

 

 

 

 

Occupation:

 

 

 

 

 

 

 

 

 

 

Name of employer:

 

 

Approximate monthly earnings:

 

 

List the name, address, and relationship of respondent's relative or guardian, or, if none, a friend of the respondent:

 

 

 

 

 

 

 

Name:

 

Relationship:

 

 

 

Telephone:

 

 

 

 

 

 

 

Address:

 

City:

 

State:

 

Zip Code:

 

 

 

 

 

 

Name of attorney who most recently represented the respondent:

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

City:

 

State:

 

Zip Code:

 

 

 

 

 

 

Petitioner's relationship to respondent:

 

 

 

 

 

 

 

 

 

 

 

Date of most recent filing of petition for involuntary commitment of respondent:

 

 

 

 

 

 

 

 

 

County in which petition was filed:

Petition was

G granted.

G dismissed.

 

 

 

 

 

 

 

PETITION

The petitioner comes before the court and respectfully alleges:

1.That the petitioner is 18 years of age or older.

2.That the respondent presently resides in the below named county in the State of North Dakota.

County where respondent resides:

N.D.C.C. 27-03.1-08

North Dakota Supreme Court

 

SFN 17260 (GN-1) (Rev. 03-2006)

Page 2

3.That the petitioner believes that the respondent is

G mentally ill and as a result of such condition there is a reasonable expectation of a serious risk of harm if respondent is not treated.

G chemically dependent and as a result of such condition there is a reasonable expectation of a serious risk of harm if respondent is not treated.

4.That because of the foregoing condition, the respondent requires treatment.

5.That the assertions contained in paragraph 3 are based upon the following specific facts (attach additional sheets, if necessary):

6.That the names, addresses, and telephone numbers of witnesses who will verify these facts are as follows:

Name:

Telephone:

Address:

City:

State:

Zip Code:

Name:

Telephone:

Address:

City:

State:

Zip Code:

7. That petitioner believes that G is G is not necessary to take the respondent into immediate custody and emergency treatment. [Immediate custody should be requested only if the respondent is seriously mentally impaired or chemically dependent and is imminently likely to injure the respondent or other persons if allowed to remain at liberty.]

8.[Complete only if immediate custody and emergency treatment requested.] Overt act(s) of the respondent which indicate the respondent is likely to injure themself or other persons if allowed to remain at liberty are described as follows:

9.That to the petitioner's best knowledge G The respondent is indigent.

G The respondent is not indigent.

The petitioner believes that an evaluation of the respondent's condition should be made and involuntary commitment and treatment is required.

Signature of petitioner:

Date:

Telephone:

Address:

City:

State:

Zip Code:

North Dakota Supreme Court

 

SFN 17260 (GN-1) (Rev. 03-2006)

Page 3

 

 

State of North Dakota

)

)ss.

County of ________________________)

The undersigned, being first sworn, on their oath states that the undersigned is the petitioner in the above matter, and that the facts in this petition are true to the affiant's best information and belief

X____________________________________________________________

Petitioner

Dated this ________ day of ____________________ of ________, before me personally appeared ______________________________________________

______________________________________________ who having been sworn state that to the best of their knowledge and belief the statements in this

petition are true.

X____________________________________________________________

Notary Public

(Seal)

My commission expires __________________________________________

APPROVAL OF ATTORNEY

This petition was reviewed for probable cause and I approve the filing of the petition.

Dated this ________ day of __________________ of ________.

X______________________________________________________________

Attorney

_______________________________________________________________

County

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Best ways to complete petition the court north dakota step 1

2. When the last section is filled out, proceed to enter the suitable information in all these: Name of employer, Approximate monthly earnings, List the name address and, Name, Address, Relationship, Telephone, City, State, Zip Code, Name of attorney who most recently, Address, City, State, and Zip Code.

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3. This next stage is going to be straightforward - complete every one of the blanks in That the respondent presently, County where respondent resides, and NDCC to conclude this process.

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Those who work with this form frequently get some points wrong while completing That the respondent presently in this area. Be certain to read again whatever you type in here.

4. Completing That the petitioner believes that, That because of the foregoing, That the assertions contained in, That the names addresses and, Name, Address, Name, City, Telephone, State, Zip Code, and Telephone is vital in this fourth section - make sure to take your time and be attentive with every single field!

Part no. 4 for filling out petition the court north dakota

5. This document must be wrapped up by going through this segment. Further you have an extensive set of fields that need appropriate information in order for your form usage to be complete: Address, City, State, Zip Code, That petitioner believes that G is, and Complete only if immediate custody.

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