To,
The Officer In Charge of the jail at …………
Where as the plaintiff (or defendant) on the above named suit has made application to this court
that security be taken for the appearance of ….. to give evidence (or to produce a document), on
the …………. day of….. 19 …. /20 …… and whereas the court has called upon the said…… to
furnish such security, which he has failed to do, this is to require you to receive the said…… into
your custody in the civil prison and to produce him before this court at….. on the said day and on
such other day or days as may be hereafter ordered.
Given under my hand and the seal of the court, this ……… day of ……. 19….. /20 ……

Judge