AOC-SP-303 — Affidavit and Petition for Emergency Involuntary Commitment

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01 AFFIANT (PETITIONER) INFORMATION

Affiant Full Name *

Relationship to Respondent *

Affiant Address *

Phone *

02 RESPONDENT INFORMATION

Respondent Full Name *

Date of Birth

County *

Date of These Events *

Approximate Time

03 DESCRIPTION OF RESPONDENT'S BEHAVIOR

Specific Acts Observed Within the Past 30 Days *

Bring any supporting documentation to the Magistrate: text messages, photos, screenshots, prior police reports, or medical records. You may be asked to testify under oath.

04 RISK INDICATORS

Check all that apply:

Respondent has threatened or attempted to harm themselves (suicidal statements, self-injury, suicide attempt)

Respondent has threatened or attempted to harm other persons

Respondent has access to weapons (firearm, knife, or other dangerous instrument)

Respondent appears to be under the influence of alcohol or drugs

05 BASIS FOR BELIEF OF MENTAL ILLNESS

Why Do You Believe the Respondent Is Mentally Ill? *

06 REQUESTED ACTION

Requested Relief: Petitioner/Affiant respectfully requests that the Magistrate review this affidavit and, upon finding probable cause that the respondent is mentally ill and dangerous to self or others, issue a custody order directing law enforcement to take the respondent into custody and transport them to the nearest 24-hour facility for involuntary examination and evaluation pursuant to G.S. 122C-261(a).

Date of Petition *

Additional Information for the Magistrate:

SELECTED COUNTY

— Select above —

⚠ CALL 911 IF ACTIVELY DANGEROUS

This form starts a legal process. If the respondent is actively threatening violence or is in immediate danger, call 911 first. Then bring this petition to the Magistrate.

Mental health crisis line: 988

WHAT THIS FORM DOES

Initiates emergency IVC — the fastest track
Magistrate available 24 hours / 7 days per week
If approved, law enforcement transports respondent to 24-hour evaluation facility
Evaluation period up to 24 hours
This is NOT the final commitment order — only the start of the process

BRING TO MAGISTRATE

This completed petition / affidavit
Text messages, voicemails, or screenshots
Photos of injuries or evidence of self-harm
Prior police reports or incident reports
Prior medical or psychiatric records (if available)
Any witness names who can corroborate facts

STATUTORY REFERENCE

G.S. 122C-261(a)Emergency petition / custody order

G.S. 122C-263Facility examination (24hr)

G.S. 122C-268Commitment hearing

NEED LEGAL HELP?

If the respondent contests the IVC at the commitment hearing, they have a right to an attorney. Barker Richardson, PLLC handles IVC matters across NC.

CONTACT BARKER RICHARDSON →

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