And you, the keeper of the prison, are directed to receive each of the persons into your custody in the prison and keep each person safely until the day when that person’s remand expires and then to have that person before me or any other justice (or if the signatory is not the justice, before any justice) on (date), at (hour), at (place), there to answer to the charge and to be dealt with according to law, unless you are otherwise directed before that time.

Dated (date), at (place).

(Signature of justice or clerk of the court)