Form PC113 "Appeal of Commitment and Order to Reconvene Commitment Review Panel" - Michigan

What Is Form PC113?

This is a legal form that was released by the Michigan Circuit Court - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 1998;
  • The latest edition provided by the Michigan Circuit Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form PC113 by clicking the link below or browse more documents and templates provided by the Michigan Circuit Court.

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Download Form PC113 "Appeal of Commitment and Order to Reconvene Commitment Review Panel" - Michigan

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Approved, SCAO
STATE OF MICHIGAN
CASE NO.
APPEAL OF COMMITMENT AND
JUDICIAL CIRCUIT COURT
ORDER TO RECONVENE
COUNTY
COMMITMENT REVIEW PANEL
In the matter of
CLAIM OF APPEAL
1. I was committed to and am presently in
,
Name of facility
as ordered by the court on
.
Date
2. I claim an appeal of my commitment.
I REQUEST that the court reconvene my commitment review panel for a recommendation as to whether my commitment should
be terminated. I understand that the court will reconvene the commitment review panel as soon as possible, but not more than
14 days after I have filed this claim of appeal.
Date
Signature
ORDER
1. Date of Hearing:
Judge:
Bar no.
IT IS ORDERED:
2. The previously appointed commitment review panel consisting of
,
Name
, and
Name
Name
shall reconvene and report to the court in writing within 14 days of the date of this order.
3. The panel shall do the following:
a. Review the appeal and any other information considered relevant by the commitment review panel.
b. Interview the individual, or document the reasons why the individual was not interviewed.
c. Recommend to the circuit court either termination or continuation of the commitment and document the reasons for the
recommendation.
Date
Judge
Do not write below this line - For court use only
MCL 333.5205(10); MSA 14.15(5205(10), MCR 5.782
APPEAL OF COMMITMENT AND ORDER TO RECONVENE COMMITMENT REVIEW PANEL
PC 113 (6/98)
Approved, SCAO
STATE OF MICHIGAN
CASE NO.
APPEAL OF COMMITMENT AND
JUDICIAL CIRCUIT COURT
ORDER TO RECONVENE
COUNTY
COMMITMENT REVIEW PANEL
In the matter of
CLAIM OF APPEAL
1. I was committed to and am presently in
,
Name of facility
as ordered by the court on
.
Date
2. I claim an appeal of my commitment.
I REQUEST that the court reconvene my commitment review panel for a recommendation as to whether my commitment should
be terminated. I understand that the court will reconvene the commitment review panel as soon as possible, but not more than
14 days after I have filed this claim of appeal.
Date
Signature
ORDER
1. Date of Hearing:
Judge:
Bar no.
IT IS ORDERED:
2. The previously appointed commitment review panel consisting of
,
Name
, and
Name
Name
shall reconvene and report to the court in writing within 14 days of the date of this order.
3. The panel shall do the following:
a. Review the appeal and any other information considered relevant by the commitment review panel.
b. Interview the individual, or document the reasons why the individual was not interviewed.
c. Recommend to the circuit court either termination or continuation of the commitment and document the reasons for the
recommendation.
Date
Judge
Do not write below this line - For court use only
MCL 333.5205(10); MSA 14.15(5205(10), MCR 5.782
APPEAL OF COMMITMENT AND ORDER TO RECONVENE COMMITMENT REVIEW PANEL
PC 113 (6/98)