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NDENT DATE: CASE NUMBER - MH - If this application is GRANTED, distribute copies of the application and Pickup/Custody Order (Form INV 4 / Form 903CCF or INV 5 / Form 903CCF24) to: Applicant, Respondent, Respondent's Attorney, Prosecuting Attorney and the Regional Mental Health Center. APPLICATION FOR INVOLUNTARY CUSTODY FOR MENTAL HEALTH EXAMINATION West Virginia Code: 27-5-2 DO NOT USE THIS FORM IF THE PERSON TO BE EXAM.

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