Name

County Attorney

Address

City, State, Zip

Telephone Number

Attonrey for Petitioner

MONTANA JUDICIAL DISTRICT COURT, COUNTY

* CAUSE NO.

IN THE MATTER OF *

* JUDGE

, *

* NOTICE OF PETITION FOR

Respondent. *

* COMMITMENT TO MENTAL

*

* * * * * * * * * * * * * * * * HEALTH FACILITY

PLEASE TAKE NOTICE that , County Attorney of , County, Montana, has filed a Petition in the District Court of the Judicial District of the State of Montana, in and for the County of , alleging that is a seriously mentally ill person and requesting that he be committed to State Mental Hospital, a mental health facility for a period not exceeding days.

The name and address of Respondent's attorney:

NAME ADDRESS

The name and address of the Professional Person:

NAME ADDRESS

The name and address of the Responsible Person:

NAME ADDRESS

NO FURTHER NOTICE WILL BE GIVEN, except to Respondent and his attorney, UNLESS WRITTEN REQUEST IS FILED WITH THE CLERK OF COURT OF THE ABOVE-ENTITLED COURT.

DATED this day of , 19 .

Name

County Attorney