Santa Clara — PB-4054*

Source: https://santaclara.courts.ca.gov/system/files/forms/pb-4054_rem.pdf

ATTACHMENT PB-4054 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address): FOR COURT USE ONLY

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ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA COURT ADDRESS: 191 North First Street CITY AND ZIP CODE: San José, California 95113 DIVISION: Probate Division

In the Matter of the Application of:

CASE NUMBER:

WRIT OF HABEAS CORPUS (RE: QUARANTINE DETENTION)

1. TO THE SANTA CLARA COUNTY PUBLIC HEALTH DEPARTMENT:

YOU ARE ORDERED TO APPEAR to show cause at the hearing noted below why the Petitioner should

not be released from quarantined confinement.

Superior Court of California, County of Santa Clara
191 North First Street, San José, CA 95113

Date: Time: Dept.

Department Phone Number: (408) 882-

2. TO THE CLERK OF THIS COURT: You are directed to serve this writ with the attached order to all

   interested parties by fax or email. If the Petitioner does not have fax or email capabilities and is self-

   represented, then you may give notice of the court date by phone as indicated in the petition. (Attach the

   original fax confirmation or printed email to this writ as proof of service for the file.)

[SEAL]

Date: Clerk, by , Deputy

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PB-4054 NEW 07/01/11 WRIT OF HABEAS CORPUS Page 1 of 1 (RE: QUARANTINE DETENTION)