Notice To Respondent Of Application And Hearing {MH-205LC}

<document>COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGEJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)IN THE MATTER OF:CASE NO. Respondent, alleged to be Mentally Ill.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TONOTICE TO RESPONDENT OF APPLICATION AND HEARINGTo: GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.You are hereby notified that on the day of , 20 , Dr. , Chief Clinical Officer/designee of North Coast Behavioral Health Care System (NBHS), filed in this Probate Court an APPLICATION FOR (CONTINUED) COURT ORDERED MEDICATION. A hearing on that application will be held on at o'clock .M. at North Coast Behavioral Health Care System (NBHS)-Toledo Campus 930 S. Detroit Avenue, Toledo, Ohio 43614. has been appointed to represent you at this hearing. Phone: Address: .Witness my signature and seal of the Court, this day of , 20., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) forJudge Jack R. Puffenberger ByDeputy ClerkOffice and P.O. Address«ni316md@-Telephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:7/1/02FORM MH-205LC-NOTICE TO RESPONDENT OF APPLICATION AND HEARING (MEDICATION)American LegalNet, Inc. www.USCourtForms.com</document>