SC.

To the sheriff, his or her deputy or to either of the town sergeants or constables in the county of ………………………………….

(SEAL)         Greeting:

Whereas ………. of ………. at a DISTRICT COURT holden at ………. did on the ………. day of ………. recover judgment of said court against ………. of ………. for the sum of ………. debt or (damages), and costs of suit taxed at ………. , as of record of said court doth appear, which sums, in the whole, amount to ………. for which execution remains to be done: We command you, therefore, that of the goods and chattels and real estate of the said ………. within your precinct, you levy the said sum of ………. , together with 15 cents for this execution, as also your lawful fees for serving the same, and therewith satisfy and pay the said ………. ; [and for want of the goods and chattels and real estate of the said ………. to be by you found within your precinct, to satisfy and pay the same sums aforesaid, we command you to take the body of the said ………. into your custody, and ………. safely secure in our jail in ………. until ………. satisfy and pay the said ………. the sums aforesaid and your fees, or until ………. be by the said ………. therefrom discharged, or otherwise by order of law.]

Hereof fail not, and make true return of this writ and of your doings thereon, on the ………. day of ………. A.D. ………. .

Witness, the seal of the district court of the ………. judicial district, this ………. day of ………. in the year ………. .

, Clerk (or Justice.)?