N.Y. Comp. Codes R. & Regs. tit. 14, Appendices, app 104-A
NACC C-16
(Auth Reg § 2007.1)
STATE OF NEW YORK NARCOTIC ADDICTION CONTROL COMMISSION
N. A.C.C. NO. ________
N. Y.S.I.I.S. NO. ________
WARRANT FOR ARREST AND DETENTION OF
DELINQUENT NARCOTIC ADDICT (M.H.L. 211.4)
TO ANY STATE POLICE OFFICER OR ANY OTHER PEACE OFFICER IN THE STATE:
Having reasonable cause to believe that ________, a narcotic addict certified to the custody of the Narcotic Addiction Control Commission, has escaped or disappeared from lawful custody or supervision and has been duly declared delinquent by the said Commission, now, therefore, pursuant to the provisions of Article 9 of the Mental Hygiene Law and the regulations of the Narcotic Addiction Control Commission, I hereby order that said narcotic addict be arrested, placed in detention, and returned to the custody of the Narcotic Addiction Control Commission, and for so doing this shall be your sufficient warrant.
NEW YORK STATE NARCOTIC ADDICTION
CONTROL COMMISSION
Dated: ________, 19________ Per
____________
Authorized Signature
____________
Typed Signature
____________
Address
________
I HEREBY CERTIFY that I executed the above warrant at ________ o'clock in the ________ noon on the ________ day of ________, 19 ________, by apprehending the above-named narcotic addict and placing him in a place of detention on behalf of the Narcotic Addiction Control Commission; and that at the time of apprehension of the said narcotic addict, I exhibited the appended warrant and informed the said narcotic addict of the purpose for which he was being taken into custody.
Dated: ________, 19________ ________
Note:
N.Y. Comp. Codes R. & Regs. tit. 14, Appendices, app 104-A