Criminal Code

Canada,

Province of ,

(territorial division).

To the sheriff of (territorial division) and to the keeper of the (prison) at :

You are hereby commanded to arrest, if necessary, and take (A.B. and C.D. as the case may be) hereinafter called the defaulters, and to convey them safely to the (prison) at and deliver them to the keeper thereof, together with the following precept:

You, the keeper, are ordered to receive the defaulters into your custody in this prison and keep them safely there for a period of or until satisfaction is made of a judgment debt of dollars due to Her Majesty the Queen in respect of the forfeiture of a recognizance entered into by on (date).

Dated (date), at (place).

(Signature of judge of the court or clerk of the court)

(Seal, if required)