R84 d Final

12/01/2020

OMB 1110-0051 

R-84 (d) 

 

1) Please provide supporting documentation with the judge's signature showing the subject was adjudicated as a mental defective.

 

2)  Was the subject committed to a mental institution?  Please specify if the subject was voluntarily or involuntarily committed.

 

3)  Please provide supporting documentation that the subject was involuntarily committed.

 

4)  Was the subject granted a relief from disability?  If so, please provide a copy of the relief from disability. 

5)  Please provide a final disposition (Judgement, Sentencing Order, Docket Sheet, Complaint, Judgement and Commitment, Disposition Report, Conviction) 

6)  Please provide level of conviction (felony, misdemeanor, violation, summary, etc.) and the degree (felony 1^st, misdemeanor 2^nd, etc.) 

7)  What is the statute and subsection of the convicting offense? 

8) Please advise if the subject is under indictment/information for a felony or misdemeanor with a maximum punishment that exceeds two years.  If under indictment or information, please provide the date the subject was placed under indictment or information.

 

9)  Please provide a copy of the police/incident report with full narrative.  If applicable, please provide any associated/referenced reports.   

10)  Please submit all supporting documentation regarding this individual along with your agency’s response.