Fill and Sign the Mississippi Judgment Form

IN THE CHANCERY COURT OF       COUNTY, MISSISSIPPI       PLAINTIFFS VS. CAUSE NO.             DEFENDANT COMPLAINT FOR JUDGMENT OF COMMITTAL TO       HOSPITAL COMES NOW,       and       Plaintiffs, and files this their Complaint against       , Defendant, and in support thereof would respectfully show unto the Court the following facts, to- wit: I. Plaintiffs are adult resident citizens of       County, Mississippi. Defendant is an adult resident citizen of       County, Mississippi, who may be served with process at his/her residence, which is       . II. That the Plaintiffs are       and       , respectfully, of the Defendant. III. That the Defendant is an alcoholic who is powerless over alcohol and his/her life has thereby become unmanageable. IV. That the Defendant's mental and physical health, his/her continued family life and his/her position in the community are dependent upon his/her treatment at a chemical dependency unit providing treatment for chemically dependent, alcoholic persons. V. That the Defendant has refused to commit himself/herself to such private treatment facility, although having been requested to do so by the Plaintiffs, who genuinely care for his/her well-being. VI. The Plaintiff has selected       Hospital, being a public treatment facility which is located in this State and which has been approved by the Department of Mental Health, Division of Alcohol and Drug Abuse. VII. 1 Such facility has approved the admission of the Defendant, subject to commitment by the Court herein. VIII. That the Defendant is under the influence of alcohol to the extent that if the Defendant is served with process he/she will, in all likelihood, flee the jurisdiction of the Court of physically harm himself/herself or others. Therefore, the Court should set this matter for hearing not more than five (5) days, excluding Saturdays, Sundays and legal holidays, from the filing of the Complaint and order the Defendant committed and confined, without notice, until the hearing, at       Hospital, being a chemical dependency unit for the treatment of chemically dependent, alcoholic persons. IX. The Court should order assistance of the Sheriff of       County, Mississippi, to confine and transport the Defendant to the facility, all as provided by law. WHEREFORE, PREMISES CONSIDERED, Plaintiffs pray that the Court will set a date for hearing on this matter not more than five days, excluding Saturdays, Sundays and legal holidays, from the filing of the Complaint, and order the Defendant committed and confined without notice, until the hearing to       Hospital, being a chemical dependency unit, for the treatment of chemically dependent, alcoholic persons, and that upon a hearing hereon and evidence adduced that the Court will find that the Defendant is an alcoholic and is in need of attention, care and treatment in a private treatment facility and shall order that the Defendant be committed to or confined in       Hospital, being a chemical dependency unit for the treatment of chemically, dependent, alcoholic persons, for such periods of time as the Court shall determine, in its discretion, as is necessary to provide for such care and treatment of Defendant, or for such periods of time as may be established by authorized personnel at       Hospital. Plaintiffs pray for general relief. __________________________       __________________________       2 STATE OF MISSISSIPPI COUNTY OF       PERSONALLY came and appeared before me, the undersigned authority of law in and for the above styled jurisdiction, the within named       and       who having been by me first duly sworn, state on their oath that all the matters, facts and averments contained in the above and foregoing Complaint are true and correct as therein stated. ________________________________       ________________________________       SWORN TO AND SUBSCRIBED BEFORE ME, this the       day of       ,       . ________________________________ NOTARY PUBLIC MY COMMISSION EXPIRES: _______________________       3