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. 44, No. 51, December 21, 2022
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:
PLEASE TAKE NOTICE that the above application will be submitted to the court on:
[Date] ________
[Time] ________
ORDER
________
PEOPLE OF THE STATE OF NEW YORK
vs.
________
Defendant
________
Present:
Honorable ____________
Justice of the Supreme Court
Judge of the County Court
This court having 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, of if he she does not have a dangerous mental disorder, whether the said defendant is mentally ill,
And, the aforesaid examination order directing that the above-named defendant be confined in a secure facility for a period not exceeding 30 days,
And, the psychiatric examiners designated by the Commissioner of Mental Health pursuant to the aforesaid examination order having commenced their examination of the above-named defendant,
And, the 30-day period referred to in the aforesaid examination order expiring on [date] ________,
And, an application having been made by the Commissioner of Mental Health for an order authorizing confinement of the above-named defendant, pursuant to the aforesaid examination order, for an additional period not exceeding 30 days,
And, due deliberation thereon having been had,
And, the court having found that a longer period is necessary to complete the psychiatric examination ordered by this court,
It is hereby
ORDERED, that the Commissioner of Mental Health is authorized to continue confinement of the above-named defendant in a secure facility pursuant to the aforesaid examination order for an additional period not exceeding 30 days.
Dated: ________
____________
Justice of the Supreme Court
Judge of the County Court
