California Welfare And Institutions Code Section 5205

The petition shall be in substantially the following form: In the Superior Court of the State of California for the County of ____________ __________________________________________ The People of the State of California No. ________ Concerning Petition for __________________________________ and Evaluation ______________________________________ Respondents __________________________________________ __________, residing at ________ (tel. ______), being duly sworn, alleges: That there is now in the county, in the City or Town of ____, a person named _____, who resides at ______, and who is, as a result of mental disorder: (1) A danger to others. (2) A danger to himself or herself. (3) Gravely disabled as defined in subdivision (h) of Section 5008 of the Welfare and Institutions Code (Strike out all inapplicable classifications). That the person is ______ years of age; that __ the person is ____ (sex); and that __ the person is ____ (single, married, widowed, or divorced); and that ____ occupation is ____. That the facts upon which the allegations of the petition are based are as follows: That __ the person, at ____ in the county, on the ____ day of ____, 20__, ___________ ____________________________________________________________ ____________________________________________________________ That petitioner`s interest in the case is _______________ ____________________________________________________________ That the person responsible for the care, support, and maintenance of the person, and their relationship to the person are, so far as known to the petitioner, as follows: (Give names, addresses, and relationship of persons named as respondents) Wherefore, petitioner prays that evaluation be made to determine the condition of __________, alleged, as a result of mental disorder, to be a danger to others, or to himself or herself, or to be gravely disabled. ________________________________ Petitioner Subscribed and sworn to before me this ____ day of ______ 20__. _____________________, Clerk of the Court By ________________________ Deputy