Fillable NOTICE AOC-1025 Doc Code: NO Rev. 3-20 Page (Administrative Office of the Courts)

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NOTICE AOC-1025 Doc Code: NO Rev. 3-20 Page (Administrative Office of the Courts)

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AOC-1025 Doc Code: NO
Rev. 3-20
Page 1 of 1
Commonwealth of Kentucky
Court of Justice www.kycourts.gov
KRS 212.245; 902 KAR 2:050
Case No. ____________________
Court ________________________
County ______________________
Division ______________________
IN RE: ( check one) q ISOLATION q QUARANTINE q MEDICAL TESTING OF ________________________________________,
[Individual's Name]
TO: ____________________________________________
____________________________________________
_____________________________________________
[Address]
[Individual's Name]
Served by:___________________________________________________________________, 2_______
Date
_________________________________________Title
PROOF OF SERVICE
This Notice was served by delivering a true copy of the Petition/Affidavit and Order to: ______________________ __
____________________________________________________________________________________________
this ________ day of _______________________, 2______.
____________________________________________
Clerk
_______________________________, 2______
Date
By: _______________________________________ D.C.
You are hereby NOTIFIED that this Court has entered the attached ORDER for (check one)
q Isolation q Quarantine q Medical testing
as requested by the ____________________________________________ pursuant to KRS 212.245(6) and 902 KAR
2:050. The petition/affidavit filed by ____________________________________________ in support of this Order is also
attached to this Notice.
[local health department name]
[local health department name]
THE COMMONWEALTH OF KENTUCKY TO ABOVE-NAMED INDIVIDUAL:
TO REQUEST A HEARING, you must contact the ______________________ Circuit Court Clerk’s Office at
______________________ and a telephonic hearing will be scheduled. If you cannot afford an attorney, you must tell the
Clerk when requesting the hearing, and one will be appointed for you.
[county]
[phone number]
You are further NOTIFIED that if you can show good cause why (check one)
q your continued Isolation q your continued Quarantine q Medical testing
is not medically necessary for the protection of others, you have the RIGHT TO REQUEST A HEARING on this matter and
TO BE REPRESENTED BY AN ATTORNEY. If you cannot afford an attorney, one will be appointed for you.
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NOTICE AOC-1025 Doc Code: NO Rev. 3-20 Page (Administrative Office of the Courts)

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Completed 28 January 2021

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