Free IN THE SUPERIOR COURT FOR THE STATE OF ALASKA - Alaska

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT __________________ In the Matter of the Necessity for the Hospitalization of: , Respondent. ) ) ) ) ) )

Case No. NOTICE OF EXTENSION OF COMMITMENT PERIOD

TO:

Respondent Superior Court at Respondent's Attorney Respondent's Guardian Assistant Attorney General

You are hereby given notice that the above-named respondent was absent without permission from , 20____, _____ ___.m. to ___________________, the treatment facility from 20____, _____ ___.m. During that time the respondent was not receiving treatment and for this reason, due to respondent's mental condition, he/she requires a continuation of treatment beyond the original time of commitment for a period of time equal to respondent's absence.

Date

Signature Print Name and Title

I certify that on a copy of this notice was sent or given to: respondent court By Facility Personnel: ______________

I certify that on a copy of this notice was sent or given to: respondent's attorney respondent's guardian assistant attorney general Court Clerk:

MC-435 (3/01)(st.3) NOTICE OF EXTENSION OF COMMITMENT PERIOD

AS 47.30.805(b)