Fill and Sign the 1 in the Chancery Court of Harrison County Mississippi Second Form

IN THE CHANCERY COURT OF COUNTY, MISSISSIPPI AND V. COMPLAINT FOR COMMITTAL COMES NOW , Plaintiff, and files this his/her Complaint to commit , Defendant, to a private treatment facility for treatment of chemical dependency, and in support thereof would show:I. Respondent is a year old female/male , and may be found at this time in County, Mississippi, at , , Mississippi .2. Complainant , , , , telephone , is the father/mother of the Respondent and is genuinely interested in Respondent's welfare.3.Respondent is a drug addict, i.e., Respondent is powerless over drugs and Respondent's life has thereby become unmanageable. Respondent is addicted to .4. Respondent's mental and physical health continued family life and position in the community are dependent on Respondent's treatment at a private treatment facility providing treatment for chemically dependent persons.5.Respondent has refused to commit himself/herself to such private treatment facility, though having been requested so to do by persons who genuinely care for Respondent’s well-being.6.Complainant has selected to treat Respondent at , , , MS . Said facility is a private treatment facility, approved by , Division of of the State of Mississippi.7. Complainant has made adequate financial arrangements for Respondent's treatment at such facility.8.Such treatment facility has approved the admission of Respondent, subject to commitment by this Court.9.The Respondent is under the conscious influence of the need for drugs to the extent that if Respondent is served with process, Respondent will, in all likelihood, flee the jurisdiction of the Court or physically harm himself/herself or others, and Respondent should be committed and confined, without notice, until a hearing, to such private treatment facility to include primary and extended care and to include psychiatric care and medication, if needed and prescribed and ordered by the medical director of the facility, and that such private treatment facility be ordered to release information to Plaintiff's attorney as to whether Respondent has executed a Waiver in this cause. WHEREFORE, PREMISES CONSIDERED, Complainant prays that Respondent be committed to such treatment facility for treatment for chemical dependency until released by authorized personnel at such treatment facility.Complainant prays for general relief Respectfully submitted,