N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. VI, form 16-h
C.P.L. Article 730
FORM 16-h
12/88
APPLICATION FOR
ORDER OF RETENTION
________ COURT OF ________
COUNTY OF ________
________x
IN THE MATTER
OF
The Application for an Order APPLICATION FOR
of Retention Pursuant to the ORDER OF RETENTION
Criminal Procedure Law
of Indictment No. ________
________
An Incapacitated Person
________x
The Director of ________ Facility, located at ________ hereby respectfully makes application to this court for an order of retention, pursuant to section 730.50 of the Criminal Procedure Law, authorizing continued custody of the above named defendant.
The said defendant was committed to the custody of the Commissioner of (OMH) (OMRDD) by court order dated ________, and thereafter retained in such custody by further order or orders of retention each dated ________ (indicate if none), and said defendant is now confined, pursuant to the designation of said commissioner, at ________ Facility, of which I am in charge.
Said defendant has been carefully observed and examined, and it is my opinion that the defendant continues to be an incapacitated person.
Annexed hereto is a summary of the defendant's history and condition which supports that opinion, a copy of the indictment and a copy of each said order.
It appears that the maximum term of imprisonment for the highest class of felony charged in the indictment or of which the defendant was convicted is ________ years and that two-thirds of such maximum term is ________ years, ________ months, ________ days.
The aggregate of the periods for which the defendant was authorized to be retained pursuant to the order of commitment and any subsequent order of retention is, as of the date of this application, ________ years, ________ months, ________ days and the aggregate of the periods of escape from custody is, as of the date of this application, ________ years, ________ months, ________ days.
WHEREFORE, the undersigned respectfully requests this court to enter an order adjudicating the defendant to be an incapacitated person and authorizing the retention of the above named defendant in the custody of the Commissioner of (OMH) (OMRDD) for care and treatment in an appropriate facility to be designated by the Commissioner for a period authorized by law.
Dated: ________ ____________
Signature of Facility Director
____________
Printed Name
____________
Facility
CERTIFICATE OF SERVICE
A copy of this application was personally served upon the defendant on the ________ day of ________, 19________, with a notice of (his) (her) right to request a hearing and copies thereof have been served by mail upon the Mental Hygiene Legal Service, the District Attorney of ________County, and
_________
(I) [FN3] ( ____________ and I jointly and severally) undertake that defendant will appear in
Dated: ________ ____________
Signature of Facility Director
____________
Printed Name
____________
Facility
N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. VI, form 16-h