Form MC-413 Notice of Withdrawal of Petition and Request for Dismissal of Case - Alaska

Form MC-413 is a Alaska Superior Court form also known as the "Notice Of Withdrawal Of Petition And Request For Dismissal Of Case". The latest edition of the form was released in February 1, 2017 and is available for digital filing.

Download a PDF version of the Form MC-413 down below or find it on Alaska Superior Court Forms website.

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IN THE SUPERIOR COURT FOR THE STATE OF ALASKA
AT
In the Matter of the Necessity
)
for the Hospitalization of:
)
)
)
) Case No.
,
)
Respondent.
)
NOTICE OF WITHDRAWAL
Date of Birth:
)
OF PETITION AND REQUEST
)
FOR DISMISSAL OF CASE
A petition was filed on (date)
at
am
pm
seeking an order authorizing involuntary hospitalization of the respondent named above
et seq
pursuant to AS 47.30.700
.
Because the respondent voluntarily admitted himself or herself to the facility named below for
treatment, there is no longer a need for a court order directing the respondent’s involuntary
hospitalization. For this reason, the petition previously filed is withdrawn and this request for
dismissal has been filed.
Alaska Psychiatric Institute
PeaceHealth Ketchikan Medical Center
Bartlett Regional Hospital
Yukon-Kuskokwim Delta Reg. Hospital
Fairbanks Memorial Hospital
Date
Signature
Print Name and Title
Phone Number
Fax Number
E-mail Address
ORDER
Order Authorizing Hospitalization for
IT IS SO ORDERED. The petition is dismissed. If an
Evaluation
was entered in this case, that order is hereby vacated.
Date
Superior Court Judge
Print Name
I certify that on
a copy
of this order was sent or given to:
Respondent
Parent/Guardian
PDA
AGO
by
et seq
MC-413 (2/17)(cs)
AS 47.30.700
.
NOTICE OF WITHDRAWAL OF PETITION AND REQUEST FOR DISMISSAL OF CASE
IN THE SUPERIOR COURT FOR THE STATE OF ALASKA
AT
In the Matter of the Necessity
)
for the Hospitalization of:
)
)
)
) Case No.
,
)
Respondent.
)
NOTICE OF WITHDRAWAL
Date of Birth:
)
OF PETITION AND REQUEST
)
FOR DISMISSAL OF CASE
A petition was filed on (date)
at
am
pm
seeking an order authorizing involuntary hospitalization of the respondent named above
et seq
pursuant to AS 47.30.700
.
Because the respondent voluntarily admitted himself or herself to the facility named below for
treatment, there is no longer a need for a court order directing the respondent’s involuntary
hospitalization. For this reason, the petition previously filed is withdrawn and this request for
dismissal has been filed.
Alaska Psychiatric Institute
PeaceHealth Ketchikan Medical Center
Bartlett Regional Hospital
Yukon-Kuskokwim Delta Reg. Hospital
Fairbanks Memorial Hospital
Date
Signature
Print Name and Title
Phone Number
Fax Number
E-mail Address
ORDER
Order Authorizing Hospitalization for
IT IS SO ORDERED. The petition is dismissed. If an
Evaluation
was entered in this case, that order is hereby vacated.
Date
Superior Court Judge
Print Name
I certify that on
a copy
of this order was sent or given to:
Respondent
Parent/Guardian
PDA
AGO
by
et seq
MC-413 (2/17)(cs)
AS 47.30.700
.
NOTICE OF WITHDRAWAL OF PETITION AND REQUEST FOR DISMISSAL OF CASE

Download Form MC-413 Notice of Withdrawal of Petition and Request for Dismissal of Case - Alaska

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