STATE OF UTAH NOTICE OF PROCEEDING OF CHILD FOR COMMITMENT OF PHYSICAL CUSTODY TO _____________________________ Local Mental Health Authority

TO:

_____________________________

___________________________________

Child (person under 18 years of age)

Parent/Legal Guardian

_____________________________

___________________________________

Person who submitted petition

LMHA Representative

_____________________________

___________________________________

In accordance with Utah Code Annotated 62A-15-703(5)(b), please be informed that a commitment proceeding will be conducted to determine if ___________________________, meets the criteria established Child

in UCA 62A-15-703(4) for commitment of physical custody to ______________________________________. Local Mental Health Authority

This proceeding will be held on: _____________________, 20_____, at _________ am/pm and will be Date

Time

heard at: ________________________________________________________________________________. Address and room number

You may attend this proceeding and address the petition for commitment. If you have any questions regarding this proceeding, please contact: _________________________________________ Name/Title

Phone

_________________________________________ Name/Title

Phone

Person(s) to be notified:

Date Notified

Time Notified

How Notified (Circle One)



Child (person under 18 years of age)

___/___/___

________ AM/PM

(Verbal or Written)



Parent/Legal Guardian

___/___/___

________ AM/PM

(Verbal or Written)



Person who submitted petition

___/___/___

________ AM/PM

(Verbal or Written)



LMHA Representative

___/___/___

________ AM/PM

(Verbal or Written)

________ AM/PM

(Verbal or Written)



Other

___/___/___

Instructions: “The child, the child’s parents or legal guardian, the person who submitted the petition for commitment and a representative of the appropriate local mental health authority shall all receive informal notice of the date and time of the proceeding. Those parties shall also be afforded and opportunity to appear and address the petition for commitment.” UCA 62A-115-703((5)(b) DSAMH Form 0003 (Revised 2012)

Utah Code Annotated 62A-15-703

0003 Notice of Proceeding of Child for Commitment of Physical ...

Address and room number. You may attend ... 0003 Notice of Proceeding of Child for Commitment of Physical Custody to the Local Mental Health Authority.pdf.

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