C.P.L. Article 730 FORM 16-i 12/88

You are hereby notified that the attached application for your continued retention in the custody of the Commissioner of (OMH) (OMRDD) on the ground that you are an incapacitated person will be made to the __ Court, County of __ on __, 19 _. You have ten days from the date of service of this notice upon you to request a hearing on the issues raised by this application. You may make such request by giving notice of your desire for a hearing to your ward physician, the person in charge of the institution where you are confined, to the Mental Hygiene Legal Service or by writing directly to the court.

You are also hereby advised that the Mental Hygiene Legal Service, which is an agency of the Supreme Court of the State of New York, has been established to provide you and others interested in your welfare with assistance and information as to your rights under the law and the procedures governing your retention. You or others on your behalf are entitled to communicate with a representative of the Service at any time. A copy of this notice has been sent to the Service.

The location and telephone number of the Mental Hygiene Legal Service office serving this facility appears below.

You may communicate with the Mental Hygiene Legal Service office directly or you may request a member of the facility staff to inform the Service of your desire to see a representative. A member of the Service will then see you in this facility.