Fill and Sign the Wi District Attorney Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE MATTER OF THE CONDITION OF       Name of Subject Statement of Emergency Detention by District Attorney or Corporation Counsel       Date of Birth Case No.       • File this statement with the detention facility and court immediately. A probable cause hearing must be held within 72 hours of detention. • Please print or type all information below. All blanks must be filled in. I am the District Attorney/Corporation Counsel for       County and state that: • The subject is mentally ill, drug dependent, or developmentally disabled. • The subject evidences behavior which constitutes a substantial probability of physical harm to self or to others, as set forth in §51.15, Wisconsin Statutes. • I am authorized to file this statement by court order, pursuant to §971.14(6)(b), Wis. Stats. (copy attached). My belief is based on specific and recent dangerous acts, attempts, threats or omissions by the subject reliably reported to me as stated below: Dangerous Behavior: When:       Where:       Describe Behavior (summarize below and attach a copy of the Criminal Complaint):       See attached page. Witnesses to the dangerous behavior: Name of Witness Telephone Address Relationship                                                                                                 The subject was detained at       Name of Mental Health Facility and Unit on       , at       am. pm. Date Time ME-907 , 12/02 Statement of Emergency Detention by District Attorney or Corporation Counsel §§51.15 and 971.14(6)(b), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Statement of Emergency Detention by District Attorney or Corporation Counsel Page 2 of 2 Case No. Subject’s Street Address       City       County       State       Distribution: 1. Court – Original 2. Mental Health Detention Facility 3. Subject with Notice of Rights Signature Title       Name Printed or Typed       Telephone       ME-907 , 12/02 Statement of Emergency Detention by District Attorney or Corporation Counsel §§51.15 and 971.14(6)(b), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2