Free Hospitalization/Disability Summons - Kentucky

AOC-706 Rev. 4-01 Page 1 of 1

Summons Type: HD
01/9/2007 11:45 am Ver. 1.01

Case No.
leave blank if unknown

Court HOSPITALIZATION/DISABILITY SUMMONS County

District

Commonwealth of Kentucky Court of Justice KRS 202A, 202B and 387 IN THE INTEREST OF: Name: Address:

The Commonwealth of Kentucky to the above-named Respondent: You are hereby notified a legal action has been filed in which you are the respondent. A copy of the petition is attached. You are further notified by the appropriate block(s) checked below to: [ ] appear on ________________, 2________, ________ [ ] a.m. [ ] p.m., at (location) ____________________________________________________________________________________ to be examined by professionals qualified to assess your mental or physical well-being; [ ] appear on ________________, 2________, ________ [ ] a.m. [ ] p.m., at (location) ____________________________________________________________________________________ to be examined by professionals qualified to assess your mental or physical well-being. At your request a Professional retained by you shall be permitted to witness and participate in your examination. [ ] appear on ________________, 2________, ________ [ ] a.m. [ ] p.m., at (location) ____________________________________________________________________________________ for a hearing in this matter. Date: _____________________, 2_____ _______________________________________Clerk By: ____________________________________ D.C.

PROOF OF SERVICE Executed by delivering a copy of the summons and petition to the above-named Respondent. Date: __________________, 2______ ______________________________________ Signature _____________________________________ Title

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