Victorian Numbered Regulations

SEVERE SUBSTANCE DEPENDENCE TREATMENT REGULATIONS 2011 (SR NO 5 OF 2011) - SCHEDULE 5

SCHEDULE 5

Sch. 5

Regulation 10

Severe Substance Dependence Treatment Act 2010
Section 22(1)

Severe Substance Dependence Treatment Regulations 2011

APPLICATION TO REVOKE A DETENTION AND TREATMENT ORDER

IN THE MAGISTRATES' COURT

OF VICTORIA AT [ venue ]             Court reference:

TO THE MAGISTRATES' COURT

The applicant applies to the Magistrates' Court for the revocation of a detention and treatment order made in respect to [ name ].

1.     DETAILS OF APPLICANT

Name:

Address:

Telephone number:     Email address:

I am:

¨     the person subject to the detention and treatment order

¨     the nominated person of the person subject to the detention and treatment

¨     the guardian of the person subject to the detention and treatment order

(please þ one option only)

2.     DETAILS OF PERSON SUBJECT TO DETENTION AND TREATMENT ORDER

Name: [ full name of person who is subject to the detention and treatment order ]

Date of birth:     Gender:

Address:     Telephone number:

Date of Order placing the person on the detention and treatment order:

PLEASE NOTE: A COPY OF THE ORIGINAL ORDER MUST BE ATTACHED TO THIS APPLICATION

Signed by the applicant:             Date: / /

PLEASE NOTE: THE APPLICANT MUST TAKE THIS APPLICATION TO THE MAGISTRATES' COURT TO OBTAIN A DATE AND TIME FOR THE HEARING OF THIS APPLICATION
Sch. 5

DETAILS OF THE HEARING [ To be completed by the Court ]
A hearing of this application will be held at [ time ] *a.m./*p.m. on [ date ] at the Magistrates' Court at [ venue ].

Date and time application filed at the Magistrates' Court: / / *a.m./*p.m.

*Delete if not applicable

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