Form CC 236 Order Committing Juvenile to Department of Health and Human Services - Michigan

Form CC236 or the "Order Committing Juvenile To Department Of Health And Human Services" is a form issued by the Michigan Circuit Court.

The form was last revised in June 1, 2015 and is available for digital filing. Download an up-to-date Form CC236 in PDF-format down below or look it up on the Michigan Circuit Court Forms website.

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3rd copy - Michigan State Police CJIC
Original - Court
4th copy - Defendant (juvenile)
1st copy - Facility
Approved, SCAO
5th copy - Prosecutor
2nd copy - Facility (for return)
STATE OF MICHIGAN
CASE NO.
ORDER COMMITTING JUVENILE TO
JUDICIAL CIRCUIT
DEPARTMENT OF HEALTH AND
COUNTY
HUMAN SERVICES
ORI
Court address
Court telephone no.
MI-
Police Report No.
Juvenile's name, address, and telephone no.
THE PEOPLE OF THE STATE OF MICHIGAN
v
CTN/TCN
SID
DOB
Prosecuting attorney name
Bar no.
Juvenile's attorney name
Bar no.
THE COURT FINDS:
1. The juvenile was found guilty on
of the crime(s) stated below.
Date
DISMISSED
CONVICTED BY
CHARGE CODE(S)
BY*
CRIME
MCL citation/PACC Code
Plea* Court Jury
Count
*Insert "G" for guilty plea, "NC" for nolo contendere, or "MI" for guilty but mentally ill, "D" for dismissed by court or "NP" for dismissed by prosecutor/plaintiff.
2. The conviction is reportable to the Secretary of State
(under MCL 257.625[20][a], MCL 257.732, MCL 324.80131, MCL 324.81134[12],
. The juvenile's driver's license number is
.
MCL 324.81135[7], MCL 324.82157, or MCL 333.7408a[11])
3. Licensing sanction reportable to State Police
.
(under MCL 333.7408a[11] or MCL 257.625[20][b])
Revoked.
Suspended
days.
Restricted
days.
4. HIV testing and sex offender registration are completed.
5. The juvenile has been fingerprinted according to MCL 28.243.
6. A DNA sample is already on file with the Michigan State Police from a previous petition/case. No assessment is required.
IT IS ORDERED:
7. The juvenile is placed on probation and committed to the Department of Health and Human Services pursuant to MCL 803.301
et seq.
(See separate order for probation.)
8. The Director of the Michigan Department of Health and Human Services is appointed special guardian to receive any benefits now
due or to become due to the juvenile from the government of the United States.
9. Pending transfer to the Department of Health and Human Services, temporary custody is as follows:
10. The juvenile is initially placed
in the home
with
Name of facility
in a treatment program as follows:
11. The Department of Health and Human Services shall forward to the court a semiannual progress report on the juvenile
.
(MCL 803.223)
12. The Department of Health and Human Services shall notify the court at least 91 days before the juvenile's 19th birthday of the
need to schedule a commitment review hearing
.
(MCL 769.16)
13. The Department of Health and Human Services shall forward to the court a commitment review report for the hearing
.
(MCL 803.225)
14. Reimbursement for the cost of care and service shall be paid as follows:
15. The juvenile shall pay:
State Minimum
Crime Victim
Restitution
DNA Assess.
Court Costs
Attorney Fees
Fine
Other Costs
Total
$
$130.00
$
$
$
$
$
$
$
16. Other:
Judge
Date
Bar no.
MCL 769.1 et seq., MCL 771.7(2), MCL 775.22, MCL 780.766
ORDER COMMITTING JUVENILE TO DEPARTMENT OF HEALTH AND HUMAN SERVICES
CC 236 (6/15)
3rd copy - Michigan State Police CJIC
Original - Court
4th copy - Defendant (juvenile)
1st copy - Facility
Approved, SCAO
5th copy - Prosecutor
2nd copy - Facility (for return)
STATE OF MICHIGAN
CASE NO.
ORDER COMMITTING JUVENILE TO
JUDICIAL CIRCUIT
DEPARTMENT OF HEALTH AND
COUNTY
HUMAN SERVICES
ORI
Court address
Court telephone no.
MI-
Police Report No.
Juvenile's name, address, and telephone no.
THE PEOPLE OF THE STATE OF MICHIGAN
v
CTN/TCN
SID
DOB
Prosecuting attorney name
Bar no.
Juvenile's attorney name
Bar no.
THE COURT FINDS:
1. The juvenile was found guilty on
of the crime(s) stated below.
Date
DISMISSED
CONVICTED BY
CHARGE CODE(S)
BY*
CRIME
MCL citation/PACC Code
Plea* Court Jury
Count
*Insert "G" for guilty plea, "NC" for nolo contendere, or "MI" for guilty but mentally ill, "D" for dismissed by court or "NP" for dismissed by prosecutor/plaintiff.
2. The conviction is reportable to the Secretary of State
(under MCL 257.625[20][a], MCL 257.732, MCL 324.80131, MCL 324.81134[12],
. The juvenile's driver's license number is
.
MCL 324.81135[7], MCL 324.82157, or MCL 333.7408a[11])
3. Licensing sanction reportable to State Police
.
(under MCL 333.7408a[11] or MCL 257.625[20][b])
Revoked.
Suspended
days.
Restricted
days.
4. HIV testing and sex offender registration are completed.
5. The juvenile has been fingerprinted according to MCL 28.243.
6. A DNA sample is already on file with the Michigan State Police from a previous petition/case. No assessment is required.
IT IS ORDERED:
7. The juvenile is placed on probation and committed to the Department of Health and Human Services pursuant to MCL 803.301
et seq.
(See separate order for probation.)
8. The Director of the Michigan Department of Health and Human Services is appointed special guardian to receive any benefits now
due or to become due to the juvenile from the government of the United States.
9. Pending transfer to the Department of Health and Human Services, temporary custody is as follows:
10. The juvenile is initially placed
in the home
with
Name of facility
in a treatment program as follows:
11. The Department of Health and Human Services shall forward to the court a semiannual progress report on the juvenile
.
(MCL 803.223)
12. The Department of Health and Human Services shall notify the court at least 91 days before the juvenile's 19th birthday of the
need to schedule a commitment review hearing
.
(MCL 769.16)
13. The Department of Health and Human Services shall forward to the court a commitment review report for the hearing
.
(MCL 803.225)
14. Reimbursement for the cost of care and service shall be paid as follows:
15. The juvenile shall pay:
State Minimum
Crime Victim
Restitution
DNA Assess.
Court Costs
Attorney Fees
Fine
Other Costs
Total
$
$130.00
$
$
$
$
$
$
$
16. Other:
Judge
Date
Bar no.
MCL 769.1 et seq., MCL 771.7(2), MCL 775.22, MCL 780.766
ORDER COMMITTING JUVENILE TO DEPARTMENT OF HEALTH AND HUMAN SERVICES
CC 236 (6/15)

Download Form CC 236 Order Committing Juvenile to Department of Health and Human Services - Michigan

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