And Whereas E.F., hereinafter called the witness, having appeared as a witness on the preliminary inquiry into the said charge, and being required to enter into a recognizance to appear as a witness on the trial of the accused on the said charge, has (failed or refused) to do so;
You, the said keeper, are hereby commanded to receive the defaulters into your custody in the said prison and imprison them 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 the ................ day of ................ A.D. ........ .