...personally examined of* *[Here insert sex, age, married or single, and occupation.] and that the said is Insane, and a proper person for care and treatment,...have formed this opinion upon the following grounds, viz. : [Here insert facts upon which such opinion rests.] And I further declare that my qualifications...

.......... examined , of the age of about .... years, .' married, and by occupation a , and that the said '.'is insane, and a proper person for care and treatment...the provisions of chapter 446, of the laws of 1874, of the State of New York. I further certify that I have formed this opinion upon the folio-wing grounds...

...personally examined , of , [here insert sex, age, married or single, and occupation,] and that the said is insane, and a proper person for care and treatment,...under the provisions of chapter 446 of the Laws of i And I further declare that my qualifications as a medical examiner in lunacy have been duly attested...

...examination of the party named had been made, and following that the opinion that the said party was insane and a proper person for care and treatment under the provisions of the statute. The declaration of insanity is an entirely distinct one from the succeeding statement...

...personally examined CD, of (here insert age, sex, married or single, and occupation), and that the said CD is insane, and a proper person for care and treatment...I further certify that I have formed this opinion on the following grounds, viz. (facts). And I further declare that my qualifications as a medical examiner...

...personally examined CD, of (here insert age, sex, married or single, and occupation), and that the said CD is insane, and a proper person for care and treatment...I further certify that I have formed this opinion on the following grounds, viz. (facts). And I further declare that my qualifications as a medical examiner...

...married or single, catc. person for care and treatment, under the provisions of section of the laws of I further certify that I have formed this opinion upon the following ground, viz.: (here insert facts upon which such an opinion rests). And I further declare that my qualifications...

...said physicians, after such examination by them personally made, if they find the person so examined insane and a proper person for care and treatment under the provisions of this act shall so certify under oath in writing according to forms hereinafter made and prescribed...

...supplied within of fact and in form of execution, for the arrest and confinement of the plaintiff as insane and a proper person for care and treatment...the provisions of chapter 446 of the Laws of 1874; that in neither of said verified certificates, nor in said approval thereof, was it declared that if...

...under oath, that on the eighteenth day of February, 1888, I personally examined i MW, age, twenty-six ; sex, female ; married ; occupation, housekeeper ;...have formed this opinion upon the following grounds : She has fits of crying and brooding over her past life, and imagines she has committed an unpardonable...