Fill and Sign the Summary of Civil Commitment Proceedingsmental Health Form

I did not carry out the order for the following reason: I took respondent into custody and transported respondent directly to and placed respondent in the custody of the facility named below. I certify that this Order was received and served as follows: Name Of State 24-Hour Facility The respondent has been charged in File No. county and has been found not guilty by reason of insanity. Therefore, the Court ORDERS the respondent committed to the State 24-hour facility named below. The Court also ORDERS the law enforcement agency named below to take the respondent into custody and transport the respondent directly to the State 24-hour facility named below for commitment. STATE OF NORTH CAROLINA RETURN OF SERVICE FINDINGS AND COMMITMENT In The General Court Of Justice District Court Division County IN THE MATTER OF: AUTOMATIC INVOLUNTARY COMMITMENT OF DEFENDANT FOUND NOT GUILTY BY REASON OF INSANITY G.S. 15A-1321; 122C-268.1 File No. Signature Of Judge Name And Address Of Respondent (Including Zip Code) AOC-SP-910M, Rev. 7/98 1998 Administrative Office of the Courts Date with a criminal offense in the above named Name Of Law Enforcement Agency To Transport Name Of State 24-Hour Facility Name Of Judge (Type Or Print) Signature Of Law Enforcement Officer Date Delivered Date Respondent Taken Into Custody Name Of Transporting Agency Date Of Return Date Order Received