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
unto, Steward of the Insane Hospital, at Augusta,
or to his successor in said office, in the sum of two hundred
dollars, to the payment of which sum, well and truly to be
made to him the said
or to his successor in said
office, we bind ourselves, our executors and administrators,
firmly by these presents.

Sealed with our seals, and dated at
day of, A. D. 18,

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,

ANNUAL REPORT

OP TEX

BOARD OF EDUCATION,

1848.