IA.B.,Barmaster of the Soke and Wapentake of Wirksworth [orLiberty of ], in obedience to the within-written Warrant, and by Authority of the same, did on the Day of 185 execute the same [by delivering to the Plaintiff within named Possession of, &c.]or[by levying the Sum of£ within mentioned, together with£ the Fees and Expenses allowed for the Execution thereof, by Sale of, &c.], and the said Sum of£ has been applied by me in discharging the Fees and Expenses of the said Levy, and the said Sum of£ has been paid by me to .

As witness my Hand, this Day of 185 .