Whereas I, A. B., on  .................... day of  .................... A.D. 20  ......., became bail for C. D., in the sum of  .................... dollars, for his appearance before the Superior Court within and for the county of  ...................., on the  ................. day of ............. next; the said C. D. being charged with the crime of ..................; I now request you to grant me a warrant, in due form of law, to apprehend the body of the said C. D., that I may commit him to jail in  the county of  ...................., in discharge of my recognizance.

Dated at, etc.