A legal commitment warrant for the Commonwealth of Massachusetts. This, along with two copies of the "Certificate of Insanity" I posted earlier this week, would comprise the "commitment papers" used to send a patient to a mental hospital in the 1920's.
Print both sides of the warrant on a light blue or gray heavy bond paper, and the two certificates on heavy bond white paper. Fill out the forms, preferably with a fountain pen. Stack the sheets with the warrant on the bottom, seal side facing down, topped by the certificates, and then fold the stack into thirds.
You can download the PDF from Google Documents by clicking here.