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
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. ____________
