In the matter of the condition of




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STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY

For Official Use



IN THE MATTER OF THE CONDITION OF
     

Name of Subject

 Amended

Order of


 Commitment

 Extension of Commitment


 Dismissal

(Fifth Standard Under
§51.20(1)(a)2.e, Wis. Stats.)


     

Date of Birth

Case No.      

A hearing was held on (Date)       .




THE COURT FINDS:

 1. Grounds for  commitment  extension of commitment have not been established.


 2. Grounds for  commitment  extension of commitment have been established. The subject is

a. mentally ill.

b. dangerous because the subject evidences behavior under §51.20(1)(a)2.e., Wisconsin Statutes.

c. a proper subject for treatment.

d. a resident of

 1.       County, Wisconsin.

 2. a nonresident of the State of Wisconsin.

 3. an inmate of a Wisconsin state prison.


 3. The subject has been adjudicated pursuant to 18 USC 922(g)(4) as a “mental defective” or committed to a mental institution.
 4. Other:      

THE COURT ORDERS:

 1. This matter dismissed and the subject released from detention.


 2. The subject is committed for       months from the date of this hearing to the care and custody of the

 a.       County Department established under §§51.42 or 51.437, Wis. Stats.

 b. State of Wisconsin Department of Health Services.

3. The maximum level of treatment shall be

a. a  locked  an unlocked inpatient facility.

Subject must be discharged not later than (Date)       . (Maximum 30 days from date of commitment)

The reception facility shall be       .

Transportation to the facility shall be provided by  the sheriff.  Other:      

 b. outpatient with conditions. The conditions of outpatient commitment on the attached document are incorporated into this order. A violation of any condition may result in the subject being taken into custody by law enforcement for inpatient treatment for not more than 30 days.

Medication and treatment may be administered to the subject regardless of his or her consent.


 4. The subject is prohibited from possessing any firearm. Federal law provides penalties for, and you may be prohibited from possessing, transporting, shipping, receiving, or purchasing a firearm, including, but not limited to, a rifle, shotgun, pistol, revolver, or ammunition, pursuant to 18 U.S.C. 921(a)(3) and (4) and 922(g)(4). This prohibition shall remain in effect until lifted by the court. Expiration of the mental commitment proceeding does not terminate this restriction.

 a. Any firearm owned by subject shall be seized by       . The subject’s firearms may be found at the following location(s):      



.

Any person residing at the/these locations is required to cooperate with law enforcement attempts to seize firearms. Failure to cooperate may result in contempt sanctions.

 b. As an alternative to seizure, the following person is designated to store any firearm(s) until the firearm restriction order has been canceled:       .

c. The subject is informed of the requirements and penalties under §941.29, Wis. Stat. including imprisonment for up to 10 years, a fine not to exceed $25,000 or both.

d. The court clerk shall notify the department of justice of the restriction unless the department has been previously informed of a prohibition for this subject.
 4. Other:      

THIS IS A FINAL ORDER FOR PURPOSES OF APPEAL.

Distribution:

1. Original – Court

2. Subject

3. Attorney

4. Treatment Provider



5. Detention facility (if different)




BY THE COURT:







Circuit Court Judge




     

Name Printed or Typed




     

Date



ME-914, 02/11 Order of Commitment/Extension of Commitment/Dismissal (Fifth Standard Under §51.20(1)(a)2.e, Wis. Stats.) §51.20(1)(a)2.e, Wisconsin Statutes

This form shall not be modified. It may be supplemented with additional material.


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