CO129-504-15 Various ordinances 4-4-1927 - 29-11-1927 — Page 43

No.

Draft Order in Council.

Order made by the Governor in Council under section of the Asylums Ordinance, 1906, Ordinance No. 6 of 1906, on the

day of

1927.

The following forms are prescribed.

COUNCIL CHAMBER,

1927.

>

FORM NO. 1.

Clerk of Councils.

Application for an order for the removal to an asylum for the purpose of detention and

observation of a person believed to be of unsound mind.

Asylums Ordinance, 1906, s. 7.

that..

I..

..of..

mind. The reasons for my belief are as follows:

(a) (Result of personal observation).

Strike out the inappro- priate

paragraph.

(b) (Facts communicated to me by others).

of...

..have reason to believe

is a person of unsound

who is said to be a relative of the person in question, has been communicated with, with the following result---

ΟΥ

No relative of the person in question can be found in the Colony.

I therefore apply under section 7 of the Asylums Ordinance, 1906, for a written order authorizing the said...

to be conveyed to the (Government) Asylum and to be detained there under observation for a period not exceeding seven. days.

Dated the........

.day of..

19......

Signature of applicant.

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