CO129-436 - Acting Governor Claud Sever & Governor Sir May & Public Offices - 1916 [11-12] — Page 696

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(*) State them.

692

Form No. 17.

Certificate required under Section 335 of the Lunacy Act, 1890.

Medical Certificate of Disability of Person entitled to Bagments from a Public Department.

Name Baker

I,

James. Edward

RECE

ER 26DEC16

Establishment No..

being a person

registered under the Medical Act, 1858, and in the actual practice of my profession,

hereby certify that I have this day visited and personally examined

James Edward Baker

James Edward Baker

1

and that the said

is unable, by reason of mental

disability, to manage his affairs, and that I have formed this conclusion on the following grounds, viz.: () The wi

spy from

Dated 1 Sich bec 1916

Signed...H. Devine

Postal address in full

The

Asylum

Milton

Portmouth.

(188). Wt.38,037-127. 1500. 1/15. A.&E.W.