The condition of the above obligation is such, that whereas the above bounden  ...................., now a prisoner in the common jail in .................... in the county of  .................... and State of Vermont, by virtue of an execution in favor of  .................... of .................. in the county of  .................... and state of ...................., for the sum of  .................... dollars and ......... cents debt (or damages) and costs, and for the sum of .................... dollars and  .............. cents costs, with ................. cents for such execution and the officer's fees on the same,  to the amount of  ...................., issued on a judgment recovered before  (here set forth court, time, etc.,) and signed by (here mention the authority  signing the execution, or, when the bond is taken on mesne process, insert in  the condition,)  .................... now a prisoner in the common jail, etc.,  .................... at the suit of  ................... of ................... in the county of  .................... and State of ...................., demanding in his writ, debt (or damages) to the amount of  .................... dollars. Now, if the said  .................... faithfully and absolutely remains within the limits of such jail yard, and does not depart therefrom until he is  lawfully discharged, without committing any escape before such discharge, or doing any act by which the sheriff, as aforesaid, is damnified, in consequence  of admitting the said  ................... to the liberties of such jail yard; but at all times indemnifies and saves harmless the sheriff, in the premises; then this obligation to be void and of no effect, otherwise of force.

Signed, sealed and                                                      (L.S.)