(lCommonb.

1caltb of jfNassacbusdts

(!Certificate of lnganitp
This document does hereby serve notice that

has been certified

Legally Insane
by the Commonwealth of Massachusetts on this date of

Whereby the above named has become a Ward of the State

to be committed to an appropriate Institution of Mental Hygiene
to receive treatment for the condition of

For a period of six (6) months or more, as care shall require,

or until sufficient cause can be shown as to warrant release.

~d3.~0
fudge, District Coun

Superintendant of Institution