__________

__________

Defendant

__________

(1) The undersigned is authorized by the State Commissioner of Health to submit this application for a release order for and on behalf of the said Commissioner.

(2) This application for a release order is being submitted to the following court: [check one and print name and address of indicated court]

(3) This application for a release order is made pursuant to subdivision 12 of CPL 330.20.

(4) The above-named defendant was committed to the custody of the State Commissioner of Mental Health for confinement in a secure facility for care and treatment pursuant to

□ a commitment order issued under the provisions of subdivision 6 of CPL 330.20

□ a recommitment order issued under the provisions of subdivision 14 of CPL 330.20

by the following court on the following date:

(5) ubsequent to the issuance of the order referred to in paragraph (4) of this application, the following court issued a first retention order on the following date:

□ (6) Subsequent to the issuance of the first retention order referred to in paragraph (5) of this application, the following court issued a second retention order on the following date:

□ (7) Following the issuance of the second retention order referred to in paragraph (6) of this application, the following court issued a subsequent retention order on the following date:

□ (8) Subsequent to the issuance of the order referred to in paragraph (4) of this application, the following court issued a transfer order on the following date:

(10) This application is made upon the ground that the undersigned is of the view that the above-named defendant no longer has a dangerous mental disorder in that the defendant does not currently suffer from an affliction with a mental disease or mental condition which is manifested by a disorder or disturbance in behavior, feeling, thinking or judgment to such an extent that the defendant requires care, treatment and rehabilitation, and that because of such condition the defendant currently constitutes a physical danger to himself or others, and that the above-named defendant is no longer mentally ill in that the defendant currently does not suffer from a mental illness for which care and treatment as a patient, in the inpatient services of a psychiatric center under the jurisdiction of the State Office of Mental Health, is essential to such defendant's welfare and that his judgment is so impaired that he is unable to understand the need for such care and treatment.

(11) The annexed psychiatric reports are made a part of this application for a release order and support the view stated by the undersigned in paragraph (10) of this application. The annexed reports contain the following: (a) a description of the above-named defendant's current mental condition; (b) the past course of treatment; and (c) a history of the said defendant's conduct subsequent to his commitment to the custody of the Commissioner of Mental Health pursuant to CPL 330.20. Also annexed to this application, and made a part hereof, are the following: (a) a written service plan for continued treatment which includes the information specified in Mental Hygiene Law section 29.15(g); and (b) a detailed statement of the extent to which supervision of the above-named defendant after release is proposed.

(12) Written notice of this application for a release order has been given to the above-named defendant, counsel for the defendant, the Mental Health Information Service and the District Attorney. This written notice was given at least 10 days prior to the date that this application will be submitted to the court indicated in paragraph (2) of this application.

(13) No previous application for a release order has been made to any court.

WHEREFORE, the undersigned respectfully requests that this application be granted and that a release order issue directing the Commissioner of Mental Health to terminate the above-named defendant's inpatient status without terminating the said Commissioner's responsibility for the above- named defendant.

Signature

Type or Print Name

Title

Date: _________

PLEASE TAKE NOTICE that the above application for a release order will be submitted to the court indicated in paragraph (2) of the application on: [date and time]