Republic of the Philippines

REGIONAL TRIAL COURT

National Capital Judicial Region
Branch ___, Manila

IN THE MATTER FOR APPLICATION

FOR VOLUNTARY CONFINEMENT FOR
TREATMENT AND REHABILITTION OF Spec. Pro. Case
no._____
ARCHIE GASAPOS Y GALICIA

ARCHIE G. MARQUEZ
Petitioner
x------------------------------------------------x

PETITIONER FOR CONFINEMENT

OF A DRUG DEPENDENT IN A CENTER

COMES NOW, the Petitioner and unto this Honorable Court respectfully
manifests:

1. That Petitioner is the sister_______ of

________________________________, and is of legal age, _________________, and
with residence and postal address at ______________________, where he/she
may be served with summons;

2. That on ______________________, __________________ was

examined and found to be a drug dependent by Dr. _____________________,
______________________ Dangerous Drugs Board as shown in the attached
Medical Certificate of even date marked as Annex “A”;

WHEREFORE, Petitioner prays this Honorable Court that an Order be

issued order and confinement of ________________ at the
_____________________ until ___ that she/he is rehabilitated as certified by the
center.
________________ 2002, Manila, Philippines.

________________________
Petitioner
Republic of the Philippines)
City of Manila )S.S.
 I, ____________________, of legal age, married, and with residence and
postal address at _______________________ do hereby certify that I am the
Petitioner in the foregoing and that every statement thereof is true and correct to
my knowledge and belief.

___________________
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ___________ at

____________, affiant exhibiting to me his/her Residence Certificate No.
_______________ issued at __________ on ___________.

Administering Officer

The Clerk of Court

RTC, Manila
Branch ___

Greetings!

Please submit the petition in the above-entitled case for consideration and
approval of on the date and time of hearing as may be set by the Honorable
Court.

________________________
Petitioner