California Code, Welfare and Institutions Code - WIC § 6251

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The People

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For the Best Interest and Protection of

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___________________________________________________________

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as a ______________________________________________________

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and Concerning

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___________________________________________________ and

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___________________________________________________________

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___________________________________________________________

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_______, residing at ________ (tel. __________), being duly sworn deposes and says: That there is now in the county in the City or Town of ____________ a person named __________, who resides at __________, and who is believed to be a __________. That * * * the person is ___ years of age; that __* * * the person is _____ (sex) and that __ the person is _____ (single, married, widowed, or divorced); and that _____ occupation is __________.

 That petitioner's interest in and case is ______________________________________________________________________________________________________________

 That petitioner believes that said person is _____ as defined in Section __________.

 That the persons responsible for the care, support, and maintenance of the _____, and their relationship to the person are, so far as known to the petitioner, as follows:

(Give names, addresses, and relationship of persons named as respondents) Wherefore, petitioner prays that examination be made to determine the state of the mental health of _____, alleged to be _____, and that such measures be taken for the best interest and protection of said _____, in respect to * * * the person's supervision, care and treatment, as may be necessary and provided by law.

  Subscribed and sworn to before me this _____ day of __________, 20__.

  ________________________________, * * * Clerk of the Court

  By __________________________________________________ Deputy