WARRANT OF IMPRISONMENT ON FAILURE TO PAY MAINTENANCE

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..... description and address) has been proved before me to be possessed of sufficient means to maintain his wife ..............................................(name) [or his child..............................................(name) or his father or mother..............................................(name), who is by reason of (state the reason) unable to maintain herself (or himself)] and to have negl .....

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..... ...........; This is to authorise and require you receive the said..............................................(name) into your custody in the said Jail, together with this warrant, and there carry the said order into execution according to law, returning this warrant with an endorsement certifying the manner of its execution. Dated, this.............................................. day of .....

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