FORM OF CERTIFICATE AND ORDER FOR ADMISSION. To the Superintendent of the Maine Insane Hospital: ON complaint of of -, [being a relative, or justice of the peace, as the case may be,] that comfort is insane and a proper subject for the Insane Hospital, we have made due inquiry as required by law, and are of opinion that said is insane, and that and safety and that of others would be promoted by a residence therein. We therefore certify that is insane, and you are hereby directed to receive and detain until restored to the use of in your care reason, or otherwise discharged of FORM OF BOND. KNOW ALL MEN BY THESE PRESENTS, That we, in the county of, as principal, and of - in the county of, as sureties, are held and bound Sealed with our seals, and dated at this THE CONDITIONS OF THE ABOVE OBLIGATION ARE SUCH, That whereas of, in the county of is about to be admitted as a boarder and patient to the institution aforesaid: shall pay to said Now if the said or to his successors in said office, such sum per week for the board, washing, medicine and attendance, according to the trouble and expense incurred by said patient, in the judgment of the Superintendent for the time being, not to exceed the sum adopted by the Trustees for the regulations of the Hospital, and pay for all such necessary articles of clothing as shall be furnished the patient by the Steward, and remove from said institution, whenever they shall be thereto requested in writing by the Superintendent for the time being-and shall also pay a further sum, not exceeding fifty dollars, for all damages that may arise from injury done to furniture and other property of the institution by and the reasonable charges that may be incurred in case of elopement; payment to be made semiannually, and at the time of removal, with interest on the amount after it has become due as aforesaid: then this obligation to be null and void-otherwise to remain in full force and virtue. Witness, [L. S.] [L. s.] OF THE BOARD OF EDUCATION OF THE STATE OF MAINE. 1848. Printed by order of the Legislature. AUGUSTA: W. T. JOHNSON, PRINTER TO THE STATE, |