Sec. 40.

Secs. 39, 58, 74.

Secs. 38, 74.

Form of Notice of Death.

I, the undersigned, hereby give you notice that

admitted into this hospital (or licensed house) on the

died therein on the day of

and I, the undersigned superintendent, certify that the apparent cause of such death [as ascertained by postmortem examination (if so)] was

of

Form of License to keep a Licensed House.

I do hereby, in pursuance of the Lunacy Act, 1903-20, grant to

a license to be in force for three years from the date hereof to keep for the reception of insane persons of the male (or female)

sex (or of both sexes) the house, the particulars of which appear in the notice given on the day of

to the Colonial Secretary.

Witness my hand this

day of

One thousand nine hundred and
Governor.

Observations.

Schedule Fifteen.

Statement respecting the Criminal Insane.

(If any particulars in this statement be not known, the fact is to be so

Sec. 77.

Name in full?

Age?

stated.)

Whereas it has been duly certified under section seventy-five of the Secs. 75, 77. Lunacy Act, 1903-20, that [A.B.], a prisoner in

prison, is insane,

I hereby order the said [A.B.] to be removed to the hospital for the criminal insane at

there to remain until he has become of sound mind or until

he be otherwise discharged by due course of law.

Dated this

day of

One thousand nine hundred and

Colonial Secretary.

at

Schedule Seventeen.

I [A.B.], a medical practitioner, have this day examined [C.D.], residing Sec. 106. and hereby certify that he is still insane, and that he appears

to be kindly treated by the persons under whose care he is living.

Sec. 188.

Original Schedule re

pealed and new Schedule substituted

by No. 42 of 1920, 8. 22.

Το

Schedule Eighteen.

The Inspector General of the Insane [or the Board of Visitors of (hers specify the Institution)] hereby summon (s) and require(s) you personally to appear before him [or them] at

19 at the hour of

on the

day of o'clock in the noon, then and there to be examined and to testify the truth touching [here specify the matter] respecting which the Inspector General [or the said Board] is [or are] holding [or about to hold] an inquiry.

And you are required to have and produce at the time and place aforesaid for the inspection of the Inspector General [or the Board] all documents in your possession, custody or power relating to the matter aforesaid and particularly [here specify the document].

And take notice that if you disobey this summons you will be liable to a penalty not exceeding Ten Pounds.

INDEX OF STATUTES.