페이지 이미지
PDF
ePub
[blocks in formation]

THIS CERTIFIES, That THE STATE BOARD OF HEALTH of West Virginia hav-
ing received satisfactory evidence that...
of the county of

.., in the State of West Virginia, IS A GRADU-
ATE IN MEDICINE, having received the DEGREE OF M. D. from

in the State of
he is hereby authorized under the provisions of the Act to establish a State Board of
Health, and Regulating the Practice of Medicine and Surgery," approved March 11,
1881, to pursue the practice of his profession in this state.

Given under the hands and Seal of the State Board of Health of West Virginia,
this
day of

in the year 188.

On.

For the:

Congressional District.

[FORM OF ENDORSEMENT BY THE SECRETARY.*]

No.

[blocks in formation]

[FORM OF CERTIFICATE OF TEN YEARS' PRACTICE.]

No.

2d Series.

STATE BOARD OF HEALTH OF WEST VIRGINIA.

THIS CERTIFIES, That THE STATE BOARD OF HEALTH of West Virginia, hav-
ing received satisfactory evidence that.
of the county of

in the State of West Virginia, has been
engaged in the continuous practice of Medicine and Surgery in this State for more
than ten years, he is hereby authorized under the provisions of the Act to establish a
State Board of Health, and Regulating the Practice of Medicine and Surgery,
approved March 11, 1881, to pursue the practice of his profession in this state.

Given under the hands and Seal of the State Board of Health of West Virginia,
this
day of

, in the year 188

For the

Congressional District.

[blocks in formation]
[ocr errors]

THIS CERTIFIES, That THE STATE BOARD OF HEALTH of West Virginia, hav-
ing satisfactorily examined.
of the county of

in the State of West Virginia, and find-
ing him duly qualified as a Physician and Surgeon, he is hereby authorized under the
provisions of the "Act to establish a State Board of Health, and Regulating the Prac-
tice of Medicine and Surgery,approved March 11th, 1881, to pursue the practice of
his profession in this state.

Given under the hands and Seal of the State Board of Health of West Virginia,
this
day of

in the year 188

***

Presiding Officer of the Local Board of Health

in the County of

For the

Congressional District,

(FORM OF NOMINATION OF LOCAL OR COUNTY BOARDS.]

OFFICE OF SECRETARY,

STATE BOARD OF HEALTH OF WEST VIRGINIA.

Wheeling, W. Va..

188 TO THE HONORABLE County Court of

County. Gentlemen :- I have been instructed by the State Board of Health, to ask your concurrence in the following appointments for the Local Board of Health of.

county, as required in SECTION 6 of an act entitled "An Act Establishing a State Board of Health and Regulating the Practice of Medicine and Surgery," passed March 8th, 1881,

Respectfully Submitted,

Secretary State Board of Health. NOTE TO CLERK COUNTY COURT.- Please notify this office of the action of your Court in the matter of these appointments, and give the post office address of each member of the Local Board.

[FORM OF APPOINTMENT OF LOCAL OR COUNTY BOARDS.]

STATE BOARD OF HEALTH OF WEST VIRGINIA.

THIS IS TO CERTIFY that.

of the county of has been appointed a member of the Local Board of Health of said county, to continue in office for the term of TWO YEARS. Given under my hand, the

day of

188 M. D., Secretary.

« 이전계속 »