Use this form if you are law enforcement, a physician, or other qualified person to certify personal observation of the evaluee or the evaluee’s behavior and based on the observation or other information have reason to believe that the evaluee has a mental disorder and presents a danger to the life or safety to themselves or others.

Use this form if you are a forfeiting authority in possession of seized monies of a defendant in which the property is alleged to be associated with criminal activity and presumed to be subject to forfeiture.

For use with forms MDJ-004AG, MDJ-004C, and MDJ-004GI.

Use this form for a child who is in the custody of DSS or under guardianship of a private child placement agency.

Use this form in independent adoption cases in which parental rights have been terminated.

Use this form if you are a parent whose child is involved in an independent adoption (not agency) and your parental rights are not being terminated. 

Use this form when a child is being placed for adoption using a licensed private adoption agency.

Use this form in a CINA case to seek adoption when parental rights have not been terminated.