general, to do all acts which appertain to you in said capacity, and as the law shall charge you. In testimony whereof, I have hereunto affixed the seal of said court, and subscribed my name at St. Paul, this sixth day of June, A. D. 1899. To C. A. Kellogg, of the county and state aforesaid, greeting: Whereas, at a probate court held at the office of the judge of probate in the town of Chardon, within and for said county, on the 6th day of February, A. D. one thousand eight hundred and seventy-eight, -present H. K. Smith, judge of probate of said county,- it appearing necessary that a guardian should be appointed to take care of the property of Helen E. Tucker, who is demented and insane, of said county, aged sixty-five years, and I having the fullest confidence in your prudence, fidelity, and circumspect conduct, have, and by these presents do, constitute and appoint you, the said C. A. Kellogg, guardian of the estate of said Helen E. Tucker during her incapacity, unless sooner discharged by the court or the law. You are therefore hereby authorized and required to perform the duty of guardian to the estate of your said ward in all respects in conformity to the laws and statutes in such case made and provided. (SEAL) H. K. Smith, Judge of the Court of Probate. Form No. II161. (Mo. Rev. Stat. (1889), § 480.)1 To the Superintendent of the Missouri State Lunatic Asylum: The undersigned, of the county of Lewis, is desirous of placing in the state lunatic asylum, at Fulton, and hereby requests the admission therein, of John Doe, a resident of the county of Lewis, who is aged thirty years, and has been (Here state what the occupation of the person has been). He is a native of Monticello in the state of Missouri, and is (Here state what the relationship or circumstances of connection may be) of the undersigned. (Here should follow a written history of the case, including the alleged cause of insanity, when it commenced, and all the particulars thereto). Dated the first day of June, 1891. Richard Roe. Form No. II162.2 To the Medical Director of the New Jersey State Hospital at Morris Plains: The undersigned, of the city of Passaic, in the county of Passaic and state of New Jersey, being desirous of having John Doe, an insane person (or an indigent insane person) of the county of Passaic and state 87, § 11 et seq.; c, 214, SS 16, 19-21; c. 222, 10 et seq.; Stat. (1884), c. 234; c. 322, 7, 9; Stat. (1885), cc. 339, 385; Stat. (1886), cc. 219, 319; Stat. (1887), c. 346; Stat. (1889), cc. 90, 414; Stat. (1890), c. 414; Stat. (1891), c. 158; Stat. (1892), c. 53; Stat. (1894), c. 195; Stat. (1895), cc. 286, 390, 429. Michigan. How. Anno. Stat. (Supp. 1890), § 1930a as amended Laws (1897), Nos. 44, 120. Minnesota. Stat. (1894), SS 34613499, 4679-4698; Laws (1895), cc. 155, 156. Mississippi. Anno. Code (1892), § 2836 et seq. Missouri. 515. Rev. Stat. (1889), $$ 466 Montana. Pol. Code (1895), §§ 23002311 as amended Laws (1897), p. 163. Nebraska. Comp. Stat. (1897), § Tennessee. Code (1896), 2618 et seq. Texas. Rev. Stat. (1893), art. 112 et seq. Anno. Utah. - Rev. Stat. (1898), § 2171 et seq. 2. This is the form approved by the Board of Managers of the New Jersey State Hospital for the Insane. See N. J. Laws (1898), c. 130, $$ 1, 5; also statutes cited supra, note 2, p. 77. of New Jersey, committed to, and confined as a patient in, the New Jersey State Hospital at Morris Plains, hereby requests the admission therein of the said John Doe, for the purpose aforesaid. Said John Doe was born in Passaic on the sixth day of February, 1872, resides at number 129 Second street, in the city of Passaic, in the county of Passaic, and is a carpenter. The undersigned is a brother1 of the said John Doe. Dated the first day of January, 1899. Name of person making request, Richard Roe. P. O. address, Passaic, Passaic Co., N. J. Street and number, 129 Second street. City, Passaic. County, Passaic. State, New Jersey. Form No. 11163. (N. Car. Laws (1891), c. 15, § 9.)3 State of North Carolina,} Wayne County. I, John Doe, a resident of Wayne county, North Carolina, being of mind capable of signifying my wishes, do hereby solicit admission as a patient in the State Hospital for such a period of time as the board of directors and superintendent may deem necessary under the provisions of this chapter 15 of the laws of North Carolina, session of 1891. Witness, John Doe. Richard Roe. 2. Affidavit, Complaint, Information or Petition for Commitment. a. Of Insane Person. (1) GENERALLY Form No. II164. (Sand. & H. Dig. Ark. (1894), § 3991.)* I, Richard Roe,3 hereby certify that John Doe, a citizen or resident of Crawford county, State of Arkansas, is, to the best of my belief, insane, and that he (or she) ought to be committed to the State Lunatic Asylum for care and treatment, as his (or her) being at large 1. The degree of relation or other circumstance of connection between patient and person making the request should be stated. 2. See, generally, the list of statutes cited supra, note 2, p. 77. 3. Who may Make. -Any reputable citizen of the state may make and file this statement with the county and probate judge of the county in which the supposed insane person may reside. Sand. & H. Dig. (1894), § 3991. is dangerous to the community, or prejudicial to his (or her) chances of recovering from his (or her) condition of mental disorder. Richard Roe. Sworn to and subscribed before me this third day of May, 1896. John Marshall, County and Probate Judge. Form No. II 165.' To the Hon. Judge of the Court of Probate, for the District of Winchester. Comes John Doe,2 of the town of Winchester, and complains and informs that James Doe, residing in the town of Winchester, within said district, is an insane person as defined by law, and as such is a fit subject to be confined in an asylum, and that said person herein complained of as insane, is suffered to go about at large and unrestrained. Said complainant further avers, that he has made diligent inquiry to ascertain the names and residences of the relatives, friends, and persons interested in the person complained of, and that they are as follows: Joseph Doe, a brother residing in said town of Winchester, and complainant, also a brother. Wherefore, said complainant prays your honor to take said matter into consideration, and to make such order, providing for a hearing upon this complaint, and an examination of said James Doe, as your honor shall deem proper. Dated at Winchester, this sixth day of June, A. D. 1899. Form No. 11166. (Precedent in Gray v. Houlton, 65 Me. 521.)3 To the Selectmen of Houlton:4 John Doe. Houlton, May 10, 1873. Daniel McCann, of Houlton, complains that his brother, Charles McCann, of said Houlton, is an insane person, dangerous to the 1. Connecticut. - Laws (1895), c. 256, $2. See also statutes cited supra, note 2, p. 77. 2. Who may Make. The complaint may be made by any person, and if any insane person shall be at large, and shall be dangerous to the community, it shall be the duty of the selectmen of the town in which he resides, or in which he shall be at large, to make such complaint. Conn. Laws (1895), c. 256, § 2. 3. Maine. - Rev. Stat. (1883), c. 143, 13 as amended Acts (1897), c. 244. See also statutes cited supra, note 2, P. 77. Precedent. In Eastport v East Machias, 35 Me. 402, the notice was as follows: To the selectmen of the town of Eastport. M. B., of Eastport, community, and prays you immediately to inquire into the condition of said Charles McCann, and to take such further steps as you may deem proper in the premises. Form No. 11167. Daniel McCann. (Precedent in Bowdoinham v. Phippsburg, 63 Me. 498.)1 To the Selectmen of Bowdoinham: The undersigned complains and says that he came into this town with his wife to visit her sister, and that she is insane, and ought to be sent to the insane hospital. State of Minnesota, Į Form No. II168.3 SS. In Probate Court. Joshua B. Stackpole. John Doe, being duly sworn, on oath says that he is a resident of Ramsey county in said state, and is acquainted with James Doe, who resides at St. Paul in said state; that said James Doe is insane and a proper subject for custody, care and treatment in a hospital for the insane, and asks that the necessary steps be taken as provided by law, to investigate the mental condition of said James Doe. John Doe. Subscribed and sworn to before me this sixth day of June, 1899. John Marshall, Probate Judge. State of Missouri,) SS. Form No. 11169. (Mo. Rev. Stat. (1889), § 491.)* The undersigned, a citizens residing in the county and state aforesaid, hereby states that John Doe is insane; that his insanity is less than one year's duration; that he has not estate sufficient to support him at the state lunatic asylum, and is a resident of said county and state aforesaid. These facts can be proven by John Knox and Alexander Hamilton. Dated this first day of November, a. p. 1891. Richard Roe. 3. Minnesota. - Stat. (1894), § 4679. See also statutes cited supra, note 2, P. 77. 4. See, generally, the statutes cited supra, note 2, p. 77. 5. Who may Make.-The statement may be made by a citizen residing in the proper county, and shall be filed with the clerk of the county court. Mo. Rev. Stat. (1889), § 491. 6. Names of Witnesses. The statement must contain the names of at least two persons by whom the facts can be proven, one of whom shall be Volume 10. |