Chapter LXI: Appendix: A.--Forms

TOWN BUSINESS.

_I. Organization of a Town._

PETITION.

To the board of county commissioners of the county of __________,__________ : The undersigned, a majority of the legal voters of congressional township number ______ north, of range number ______ west, in said county, containing not less than twenty-five legal voters, hereby petition your honorable board to be organized as a new town under the township organization law, and respectfully ask that you forthwith proceed to fix and determine the boundaries of such new town and to name the same (giving the proposed name.)

(Dated, and signed by a majority of all the legal voters in the town.)

COMMISSIONERS' REPORT.

State of __________, county of __________, ss.

Upon receiving a petition of a majority of all the legal voters of congressional township number ______ north, of range number ______ west, in said county, asking that the same be organized as a new town under the township organization law, to be named __________, we, the county commissioners of said county did, on the ______ day of A.D. 18______, proceed to fix the boundaries of such new town and name the same __________, in accordance with the said petition, and designated __________ as the place for holding the first town meeting in such town, to be held on __________, 18______. The boundaries of said town of __________, as fixed and established by us, are as follows: (Beginning at the southeast corner of section ______, town ______ north, of range ______ west, thence west on the township line ______ to the southwest corner of section ______, town and range as aforesaid, thence north, &c., giving the boundary lines complete.) Given under our hands this ______ day of __________, 18______.

[Auditor's official seal.]

(Signed by the Commissioners.)

Attest: O.J., County Auditor.

II. Elections.

NOTICE OF ANNUAL ELECTION.

Notice is hereby given, that on Tuesday, the ______ day of November, 18_____, at ___________, in the election district composed of the __________, in the county of __________, and state of __________, an election will be held for (here name the state, judicial, congressional, legislative and county officers to be elected); (if constitutional amendments are to be submitted, add:) also the following amendments to the constitution of the state will be submitted to the people for their approval or rejection, viz.: amendment to section _____, article _____, of the constitution (naming each one proposed); (and if any special matters, such as removal of county seat, &c., are to be voted on, then specifically state them); which election will be opened at nine o'clock in the morning, and will continue open until five o'clock in the afternoon of the same day, at which time the polls will be closed.

Dated at ________ this _____ day of October, 18____.

C.O.S., Town Clerk (or City or Village Recorder.)

REGISTER POLL LIST.

List of qualified electors in the election district composed of the __________ of __________, in the county of __________, and state of __________, for an election to be held in the said election district, on Tuesday, the _____ day of November, 18_____:

Adams, James | Little, Joseph Babcock, George | Mann, Oscar.

(Write the surnames in alphabetical order, and leave sufficient space between the alphabetical letters to insert all additional names.)

Notice is hereby given that the undersigned judges of election of said election district, will be present at the __________, in said __________, at the times named below, for the purpose of making corrections in the foregoing list, viz.: On "Wednesday, October _____, and (here insert the days and times of the day they are to meet), from 9 o'clock A.M. till 4 o'clock P.M. of each day, and also on the morning of election day, from 7 o'clock A.M. to 9 o'clock A.M."

Given under our hands this _____ day of October, 18_____.

(Signed by all the judges of election.)

MINUTES OF TOWN MEETING.

At the annual (special) town meeting held in the town of __________, county of __________, state of __________, at _____, on the day of _____, 18 _____, the meeting was called to order by R.G., town clerk. M.J.H. was then chosen to preside as moderator of the meeting.

The moderator, at the opening of the meeting, stated the business to be transacted and the order of the same as follows: That the business to be transacted would be to elect three supervisors, &c., (stating the officers to be elected,) and to do any other business proper to be done at said meeting.

That said business would be entertained in the following order: 1st--The election by ballot of town officers, the polls to be kept open throughout the day. 2d--At one o'clock P.M., election of overseers of highways for each road district in the town. 3d--That immediately following the election of overseers of highways the general business of the town would be taken up and proceeded with until disposed of.

Proclamation of opening the polls was then made by the moderator and the polls opened and the election of town officers proceeded.

The hour of one o'clock P.M. having arrived and the general business of the town being now in order, the following named persons were elected, by ayes and noes, overseers of highways for the ensuing year in the following road districts, viz.: (here give the numbers of the road districts and the names of the persons elected overseers thereof.)

A.B. was elected poundmaster of said town. On motion, ordered that a pound, &c., (give the location, cost, &c., of pound, if ordered.)

The following three places were determined and designated by the voters present as the most public places in said town for the posting up of legal notices, and suitable posts for such purpose were ordered to be erected or maintained by the supervisors at each of such places, viz.: (describe the places.)

The supervisors submitted to the electors a report of all the places at which guide posts are erected and maintained within the town, and of all places at which, in their opinion, they ought to be erected and maintained. Thereupon, it was ordered that guide posts be erected and maintained at the following places, viz.: (describe the places.)

The town clerk read publicly the report of the board of auditors, including a statement of the fiscal concerns of the town and an estimate of the sum necessary for the current and incidental expenses of the town for the ensuing year.

The supervisors rendered an account in writing, stating the labor assessed and performed in the town, the sums received by them for fines and commutation, &c.; a statement of the improvements necessary to be made on the roads and bridges, and an estimate of the probable expense of making such improvements beyond that of the labor to be assessed for this year, that the road tax will accomplish; also a statement in writing of all expenses and damages in consequence of laying out, altering or discontinuing roads.

On motion, it was ordered that the following sums of money be raised by tax upon the taxable property in said town for the following purposes for the current year: (enter the specific amounts carefully.)

On motion of H.S.H.H., the following by-law was adopted, ayes _____, noes _____: "It is hereby ordered and determined that it shall be lawful for horses, mules and asses to run at large in the town of __________, in the day time, from the first day of April to the 15th day of October, in each year, until further ordered."

On motion, it was resolved, &c., (set forth in order each resolution or order as it transpires.)

The next annual town meeting was ordered to be held at (naming the place.)

At five o'clock the polls were closed, proclamation thereof being made by the moderator. The judges then proceeded to publicly canvass the votes, and the persons having the greatest number of votes for the respective offices voted for were declared elected.

STATEMENT OF RESULT OF CANVASS. (To be read publicly.)

The following is a statement of the result of the canvass of votes by ballot for the election of officers at the annual town meeting in the of __________, county of __________, and state of __________, March _____, 18_____, as publicly canvassed by the judges at said meeting:

H.B. had _____ votes for chairman of supervisors.

J.L. had _____ votes for chairman of supervisors.

H.B. was declared elected chairman of supervisors.

(In this way give a statement of the votes cast for each officer.)

On motion the meeting adjourned without day.

J.H.T., C.O.C., Judges

Attest: R.G., Clerk.

OFFICIAL OATH.

State of __________, county of __________, town of __________, ss.

I, J.A., do solemnly swear (or affirm) that I will support the constitution of the United States and of the state of __________, and faithfully discharge the duties of the office of __________ of the town of __________, in the county of __________, and state of __________, to the best of my ability. J.A.

Subscribed and sworn to before me this _____ day of __________ A.D. 18_____

T.S., Justice of the Peace.

OFFICIAL BOND.

Know all men by these presents, that we, R.S., as principal, and B.B.S. and J.E. as sureties, all of the county of __________, and state of __________, are held and firmly bound unto J.D.E., E.C., and E.E., as supervisors of the town of __________, in said county, and their successors in office, in the sum of (five hundred) dollars, lawful money of the United States of America, to be paid to them as such supervisors, their successors or assigns; for which payment well and truly to be made, we bind ourselves, our heirs, executors and administrators, jointly and severally, firmly by these presents. Sealed with our seals dated the _____ day of __________, 18_____.

The condition of the above obligation is such, that whereas, the above bounded R.S. was, on the _____ day of __________, A.D. 18_____, duly elected (or appointed) __________ in and for the town of __________, in said county, for the term of __________, and is about to enter upon the duties of said office; now, therefore, if the said R.S. shall, will and does faithfully discharge all his duties as such __________ in and for said town, then the above obligation to be void, otherwise to remain in full force and virtue.

R.S. [Seal.] B.B.S. [Seal.] J.E. [Seal.]

Sealed and delivered in presence of

J.B. and G.J.

State of __________, County of __________, ss.

On this _____ day of __________, A.D. 18_____, before me, the subscriber, a __________ in and for said county, personally appeared __________ to me known to be the person described in, and who executed the foregoing instrument, and acknowledged that he executed the same as __________ free act and deed.

County of __________, ss. B.B.S. and J.E., being duly sworn, say each for himself, that he is surety in the within bond; that he is a resident and freeholder of the state of __________, and that he is worth the sum of (five hundred) dollars over and above his debts and liabilities, and exclusive of property exempt from execution.

B.B.S. and J.E.

Subscribed and sworn to before me, this _____ day of __________, 18_____.

W.R.P., Justice of the Peace.

(After folding the instrument the approving officer must indorse on its back the following words:) "I hereby approve the within bond and the sureties therein contained, this _____ day of __________, 18_____."

(Signed officially by the approving officer.)

NOTICE TO CLERK OF DISTRICT COURT OF ELECTION OF JUSTICE OF THE PEACE.

State of __________, county of __________, town of __________, ss.

To H.A.B., (address,) clerk of the district court of the county of __________.

You are hereby notified that at the _____ town meeting held in the town of __________, in the county of __________, and state of __________, on the _____ day of March, A.D. 18_____, P.E.C. was duly elected to the office of justice of the peace, for the term of two years. (If elected to fill a vacancy, state who was the last incumbent.) Given under my hand, this _____ day of March, A.D. 18_____.

A.R., Town Clerk.

_III. Roads._

PETITION.

To the supervisors of the town of __________, in the county of __________, and state of __________:

The undersigned, legal voters (who own real estate, or who occupy real estate under the homestead or pre-emption laws of the United States, or under contract from the state of __________, within one mile), (or who are freeholders and residents of the town within two miles) of the road to be laid out (or altered, or discontinued), hereby petition you to lay out a new road (or alter, or discontinue a road) as follows: Beginning (give the point at which it is to commence, its general course and its termination.)

The description of the lands over which the said (new) road passes, and the names of the owners thereof which are known, as well as the lands whose owners are unknown, are as follows: (Give the owners of the lands that are known and describe the lands whose owners are unknown.)

And your petitioners pray that you will proceed to lay out said new road and cause the same to be opened (or alter, or discontinue said road) according to law. (Dated, and signed by at least six resident legal voters owning real estate or occupying United States or school lands within one mile, or at least eight resident freeholders within two miles of the road.)

PROOF OF POSTING.

State of __________, county of __________, town of __________, ss.

D.S. being sworn, says, that on the ______ day of __________, 18______, he posted copies of the within petition in three of the most public places of said town, to-wit: At (naming the places.) _________________________ D.S.

Subscribed and sworn to before me this ______ day of __________, 18______.

E.W.R., Justice of the Peace.

SUPERVISORS' NOTICE OF HEARING.

Notice is hereby given that the supervisors of the town of __________, in the county of __________, and state of __________, will meet on the ______ day of __________ A.D. 18______, at ______ o'clock in the ______noon, at __________, in said town, for the purpose of personally examining the route named below, proposed for a new (or altering, or discontinuing a) road, and for hearing all reasons for or against said proposed laying out (or altering, or discontinuance) and deciding upon said application. Said proposed new road (or alteration, or discontinuance) as described in the petition is as follows: (Here give the description of the route as contained in the petition.)

The several tracts of land through which said road will pass (passes) and the occupants thereof, as nearly as we can determine the same, are as follows: (Give a description of the lands and the names of the occupants, and if any have no occupants and the owners are unknown, state that fact.) (Dated, and signed officially by the supervisors.)

PROOF OF POSTING NOTICE.

State of __________, county of __________, town of __________, ss.

D.S. being sworn, says that on the ______ day of __________, A.D. 18______, he served the within notice upon each of the occupants of the land through which the within described road may pass, by leaving copies as follows: To A.B. personally; to C.D. at his usual place of abode with E.F., a person of suitable age and discretion, (describing each service.)

That, also, on the ______ day of __________ A.D. 18______, he posted copies of the within notice in three public places in said town, to-wit: At (naming the places.)

D.S.

Subscribed and sworn to before me this ______ day of __________, 18______.

E.W.R., Justice of the Peace.

SUPERVISOR'S ROAD ORDER.

State of __________, county of __________, town of __________, ss.

Whereas, upon the petition of (six) legal voters, owning real estate, or occupying real estate under the homestead or pre-emption laws of the United States, or under contract from the state of __________, within one mile (or eight legal voters, freeholders and residents of the town, within two miles), of the road proposed in said petition to be laid out (altered or discontinued), copies of said petition having been first duly posted up in three of the most public places of said town at least twenty days before any action was had in relation thereto, proof of which posting was duly shown to us by affidavit; Which said proposed new road (alteration or discontinuance) is set forth and described in said petition as follows, viz.: Beginning, etc., (set forth the road as given in the petition.)

And whereas, upon receiving said petition we did, within thirty days thereafter, make out a notice and fix therein a time and place at which we would meet and decide upon such application, to-wit: on the day of _____, A.D. 18_____, at __________, causing copies of such notice to be posted in three public places in said town, at least ten days previous to such meeting; and having met at such time and place as above named in said notice, and being satisfied that the applicant had, at least ten days previous to said time, caused said notice of time and place of hearing to be given to all the occupants of the land through which such highway might pass, by serving the same personally or by copy left at the usual place of abode of each of said occupants, proof of which was shown by affidavit, we proceeded to examine personally such highway and heard any and all reasons for or against laying out (altering or discontinuing) the same, and being of the opinion that such laying out (or altering, or discontinuing,) was necessary and proper and that the public interest would be promoted thereby, we granted the prayer of said petitioners and determined to lay out (alter or discontinue) said road, the description of which as so laid out is as follows, to-wit: Beginning, &c.

It is therefore ordered and determined that a road be and the same is hereby laid out (or altered) and established according to the description last aforesaid, and it is hereby declared to be a public highway, four rods wide, the said description above given being the center of said road.

Given under our hands, this, &c., (dated and signed officially by the supervisors.)

SURVEYOR'S REPORT.

To the supervisors of the town of __________, county of __________, and state of __________:

The undersigned having been employed by you to make a survey of a road in said town would report that the following is a correct survey thereof, as made by me under your directions, to-wit: (Give an accurate description of the road by course and distance) and that below is a correct plot of said road according to said survey. (Dated and signed.)

RELEASE OF DAMAGES.

State of __________, county of __________, town of __________, ss.:

Whereas, a road was laid out (or altered or discontinued) on the _____ day of __________, A.D. 18_____, by the supervisors of the said town of __________, on the petition of (six) legal voters, owning real estate, or occupying real estate under the homestead or pre-emption laws of the United States, or under contract from the state of __________, within one mile (or eight legal voters freeholders and residents of the town within two miles) of said road; which said road (or alteration, or discontinuance) is set forth and described in the supervisors' order, as follows, viz.: Beginning (describe the road as in the order laying it out); which said road passes through certain lands owned by us as described below:

Now, therefore, know all men by these presents, that we, the owners of the lands described below, for value received, do hereby * release all claims to damages sustained by us by reason of the laying out (or altering, or discontinuing) and opening said road through our lands, viz.: (Here give a description of the lands and their owners' names.)*

In witness whereof, we have hereunto set our hands and seals this day of __________, A.D. 18_____. (Signatures and seals.) Signed, sealed and delivered in presence of two witnesses.

AGREEMENT AS TO DAMAGES.

(Use form "Release of Damages" to the * then substitute to the next * as follows:) do hereby "agree to and with the said supervisors that the damages sustained by us by reason of laying out (or altering, or discontinuing) said road be ascertained and fixed, and the same are hereby ascertained and fixed as follows: (Describe the lands, give the owners' names, and the amounts agreed on;" and conclude as in form "Release of Damages.")

AWARD OF DAMAGES.

State of __________, county of __________, town of __________, ss.:

Whereas, a road was laid out (or altered or discontinued) on the day of __________, A.D. 18_____, by the undersigned supervisors of the said town of __________, on the petition of (six) legal voters, owning real estate, or occupying real estate under the homestead or pre-emption laws of the United States, or under contract from the state of __________, within one mile (or eight legal voters, freeholders and residents of the town within two miles) of said road; which said road (or alteration, or discontinuance) is set forth and described in the supervisors' order as follows, viz.: Beginning (describe the road as in the order laying it out.) And not being able to agree with the owners of the following described lands, claiming damages by reason of said highway passing through, we have assessed the damages to each of such individual claimants with whom we could not agree, and awarded damages to the owners of such lands through which such highway passes as are unknown, at what we deemed just and right; taking into account and estimating the advantages and benefits the road will confer on the claimants and owners, as well as the disadvantages. We have assessed and awarded damages as follows:

(Here give a particular description of each tract of land and its owner, if known; but if not known, state that fact also.)

And in case of the following lands and claimants for damages, we estimate that the advantages and benefits said road will confer on them are equal to all damages sustained by them by reason of laying out (or altering, or discontinuing) said road, to-wit: (Set forth lands and owners as far as known; and describe the unknown lands, stating that the owners are unknown.) (Dated, and signed by the supervisors.)

APPLICATION FOR JURY.

State of __________, county of __________, town of __________, ss.

To J.P., justice of the peace in and for said county:

I, J.A.B., of said town, feeling myself aggrieved by the determination (award of damages) made by the supervisors of said town (county commissioners of said county) by their order bearing date the _____ day of __________, A.D. 18_____, in laying out (altering or discontinuing) (or refusing to lay out, alter or discontinue) a highway in said town (county), do hereby appeal to you for a jury to be summoned by you to hear and determine such appeal.

The highway (alteration or discontinuance) in question is described in said order, filed in the town clerk's (county auditor's) office of said town (county) ________, A.D. 18_____, as follows: (describe the road, as in the order on file), which said road passes through lands owned by me, viz.: (describing them.)

The grounds upon which this appeal is brought, are: (to recover $80 damages to my said land by reason of such laying out, instead of $40 as awarded in said order) (or, in relation to the laying out, or altering, or discontinuing said highway;) (or their refusal to lay out, or alter, or discontinue said highway;) (or said appeal is brought to reverse entirely the decision of the said supervisors or commissioners;) (or is brought to reverse that part of their order [specifying which part,] &c.) (Dated and signed by the appellant.)

JUSTICE COURT.

_I. Civil Suit._

SUMMONS.

State of _____, }ss. County of ____ }

[Footnote: This brace of lines, giving the state and county as introductory to a process, certificate, affidavit or other paper, is called a "venue," and should be inserted wherever the word _(Venue)_ is expressed in forms given hereafter.]

The state of _______ to the sheriff or any constable of said county:

You are hereby commanded to summon A.M., if he shall be found in your county, to be and appear before the undersigned, one of the justices of the peace in and for said county, on the ___ day of _____ 18_____, at ___ o'clock in the ____noon, at my office in the ____, in said county, to answer to J.T. in a civil action; and have you then and there this writ.

Given under my hand this ___ day of ___, A.D. 18_____.

W.D.D., Justice of the Peace.

CONSTABLE'S RETURN.

_(Venue as in Summons.)_

I hereby certify that I personally served the within summons upon the within named defendant, by reading the same to him, in said county, on the __ day of _________, 18_____.

Fees--Mileage, 8 miles, - - .80
Service, - - - - - - - - - .15
--
.95

G.M.G., Constable.

COMPLAINT.

State of ______} ss. In Justice Court,
County of ____} Before W.D.D., Justice of the Peace.
J.T., plaintiff,
against
A.M., defendant.

[Footnote: All the affidavits, pleadings, and other papers filed by parties in an action should be "entitled," that is to say, should begin with a caption similar to the above, giving the state and county, name of justice, and the names of the parties, plaintiff and defendant, to the action. This caption (_title of cause_) is to be inserted in every form given hereafter, wherever it is so expressed.]

The complaint of the plaintiff shows to this court that at ___, in the state of ___, on the _____ day of ____, 18___, the defendant made his promissory note in writing, dated on that day, and thereby promised to pay to the plaintiff (one year after date) the sum of (eighty) dollars, for value received, with interest thereon from the said date at the rate of (ten) per cent, per annum until fully paid, and delivered the same to the plaintiff.

That the plaintiff is now the holder and owner of said note; that the same has not been paid, nor any part thereof; but the defendant is now justly indebted to the plaintiff thereon in the sum of (eighty) dollars, with interest as aforesaid.

Wherefore, the plaintiff demands judgment against the defendant for the sum of (eighty-nine) dollars and (sixty) cents, with costs of suit.

J.T. (_Venue._)

J.T., the plaintiff (or defendant) in this action, being duly sworn, says that the foregoing complaint (or answer, or reply,) is true, to his own knowledge, except as to those matters stated on his information and belief, and as to those matters, that he believes it to be true.

J.T. (_Jurat._)

ANSWER.

(_Title of cause._)

The answer of the defendant to the complaint herein, shows to this court:

1. That he admits the making and delivering of the note therein stated, but denies each and every other allegation therein contained.

2. And for a further defense this defendant shows that on the _____ day of _________, 18_____, he bought (a horse) of the plaintiff for the sum of (one hundred and thirty) dollars, and paid him (fifty) dollars in money, and the note of (eighty) dollars described in the complaint; which (horse), by the contract of sale, the plaintiff warranted to the defendant to be sound; and the defendant further states that the said (horse) was unsound at the time, whereby the defendant sustained damage in the sum of (one hundred) dollars.

Wherefore he asks that said amount of damage be set off against the amount of said note, and demands judgment for the balance of (twenty) dollars, besides costs of suit.

A.M. (_Verified._)

REPLY.

(_Title of cause._)

The reply of the plaintiff to the facts set forth in the answer of the defendant, denies each and every allegation therein contained.

J.T. (_Verified._)

ADJOURNMENT.

(_Title of cause._)

(_Venue._) A.M., being duly sworn, says, that he is the defendant in this action; that J.C.S., who resides in the town of _________, in said county, is a material witness for this defendant, without whose testimony he cannot safely proceed to the trial of this action; that the said J.C.S., if examined as a witness on the trial, will testify that he was present at the time the horse mentioned in the answer was purchased, and heard the plaintiff say to the defendant, "the horse is sound, and I warrant him so;" that he heard this defendant reply, "well, I shall rely entirely upon your warranty;" and that thereupon defendant gave his note for the balance of the purchase money of the horse.

That on the _____ day of _________, 18_____, he procured a subpoena for the said J.C.S., and went with the same to his residence to serve the same, when he there learned for the first time that said J.C.S. had unexpectedly left home the day before and had gone to _________, in the state of _________, to be absent (three) weeks. That he knows of no other person by whom he can prove these facts; and that he expects to be able to procure the attendance of said J.C.S. as a witness on the trial, if this cause is adjourned for (thirty) days.

A.M.

(_Jurat_.)

SUBPOENA.

State of ____, } ss.
County of ___}

The State of _________ to J.K., J.L. and G.G.:

You are hereby required to appear before the undersigned, one of the justices of the peace in and for said county, at my office in the town of _________, on the _____ day of _________, 18_____, at _____ o'clock in the _________ noon of said day, to give evidence in a certain cause then and there to be tried between J.T., plaintiff, and A.M., defendant, on the part of the plaintiff (or defendant.)

Given under my hand this _____ day of _________, 18_____.

W.D.D., Justice of the Peace.

ATTACHMENT AGAINST WITNESS.

(_Venue_.)

The State of _________ to the sheriff or any constable of said county:

You are hereby commanded to attach the body of S.K.B., if he shall be found in your county, and bring him forthwith before the undersigned, one of the justices of the peace in and for said county, at my office in the town of _________, in said county, to give evidence in a certain cause now pending before me, between J.T., plaintiff, and A.M., defendant, on the part of the defendant (or plaintiff); and also to answer all such matters as shall be objected against him, for that the said S.K.B., having been duly subpoenaed to attend at the trial of said action, had refused (or failed without just cause) to attend, in conformity to said subpoena; and have you then and there this writ.

Given under my hand, etc. W.B.D., Justice of the Peace.

CONSTABLE'S JURY LIST.

(_Title of cause_.)

List of names of (twenty-four) inhabitants of the county of _________, qualified to serve as jurors in the district court of said county, made by me as directed by said justice of the peace, from which to impanel a jury in the above entitled cause.

G.W., Constable.

Dated, etc.

John J. Cooke, X

Allan K. Ware,

X Jared S. Benson,

Walter G. Brown,

George W. Jones,

Elias Bedall,

Erick Peterson,

Patrick Kelly, X

X Thomas O. Jones,

Julius Graetz,

John Shannon, X

X David F. Lamb,

Wm. W. Wertsel,

X Daniel G Pratt,

Horace S Roberts, X

J.W. Everstine,

Aaron M Ozmun,

X Ole T. Ruhd,

Lars Anderson,

Conrad Schacht,

O.P. Whitcomb,

X J.Q. Leonard,

Zera Fairman, X

Russell Blakely. X

** Names struck off by plaintiff checked on the right; by defendant checked on the left.

W.D.D., Justice of the Peace.

VENIRE.

State of __________,} County of _________}ss.

The State of __________ to the sheriff or any constable of said county:

You are hereby commanded to summon (here insert the names in full), to be and appear before the undersigned, one of the justices of the peace in and for said county, on the ______ day of __________, 18______, at ______ o'clock in the ______noon of said day, in the (town) of __________, in said county, to make a jury for the trial of a civil action between J.T., plaintiff, and A.M., defendant, and have you then and there this writ.

Given under my hand this ______ day of __________, A.D. 18______.

W.D.D., Justice of the Peace.

RETURN.

(_Venue_.)

I hereby certify that, by virtue of the within writ, I have personally summoned as jurors the several persons named therein, viz. (give the list served; and if any are not served, add): and that the following named persons could not be found (giving their names.)

Dated this ______ day of __________, 18______. G.W., Constable. Fees, etc.

WARRANT FOR JUROR.

State of __________,} County of _________}ss.

The State of __________ to the sheriff or any constable of said county:

Whereas, on the ______ day of __________, A. D. 18______, a venire was duly issued by the undersigned, one of the justices of the peace of the said county, in the case of J.T. _vs_ A. M., then pending before me as such justice; and, whereas, one E.F. was duly named as juror therein, and said venire was duly served upon said E.F. by G.H., a constable of said county; and, whereas, the said E.F. failed to appear as such juror, or to render any reasonable excuse for his default, as appears from the return of said constable, and from my docket; now, therefore, you are hereby commanded forthwith to apprehend the said E.F. and bring him before me to show cause why he should not be fined for contempt in not obeying said writ, and to be further dealt with according to law.

Given under my hand, etc.

W.D.D., Justice of the Peace.

DOCKET.

(_With oral pleadings, jury trial, execution, etc._)

State of _________,} County of _______,}ss.

In Justice Court.

Before W.D.D., Justice of the Peace.

J.T., Plaintiff,

_against_

A.M., Defendant.

PLAINTIFF'S COSTS.

_Justice's Fees_.

Summons...............$ 25 Complaint............. 15 Answer................ 15 Reply................. 15 Adjournment........... 15 Oath, 2d adjt......... 15 2d adjournment........ 15 Filing two papers..... 10 3d adjournment........ 15 Swearing jury......... 25 Oath, nine witnesses.. 1 35 Oath, officer......... 15 Judgment.............. 25 Taxing costs.......... 15

$3 55

_Constable's Fees_.

On summons............$1 10 Jury list............. 15 Summoning jury........ 1 00 1 day's att. court.... 1 00 Attending jury........ 50

$3 75

_Plaintiff's Witnesses_. W.A.,att. and mil.....$1 48 L.D., " " ..... 1 24 Z.S., " " ..... 1 12 J.B., " " ..... 1 36

$5 20

$12 50

August l, 1887.--Summons issued, returnable August 9,1887, at 1 o'clock P.M.

August 5.--Summons returned by Constable S. (Here give the return of the officer.)

August 9, 1 P.M.--Parties appeared and joined issue. Plaintiff complained orally upon a promissory note, and delivered the same to the court, and stated that there was due him $80 and interest thereon, which he claimed to recover Of defendant; verified the same. Defendant answered orally, alleging that said note was given for a horse, which horse was warranted to be sound, whereas, in fact, it was unsound, claiming $100 damages thereby; verified. Plaintiff replied orally, denying the warranty; verified. Plaintiff then applied for an adjournment, and the suit was adjourned to August 16, 1887, at 1 P.M., at my office.

August 16, 1 P.M.--Parties appeared, and defendant applied for an adjournment of thirty days, to obtain material witness, and having shown cause therefor, upon oath, the suit was adjourned to September 16, 1887, at 1 P.M., at my office.

September 16, 1887, 1 P.M.--Parties appeared, and defendant demanded a jury of twelve persons, paying their fees. Venire issued and delivered to Constable G.W. Cause adjourned to September 17, 1887, at 1 P.M., at my office, to give time to summon the jury, and for them to appear.

September 17, 1 P.M.--Parties appear. Two of the jurors not appearing, G.D. and E.F. were summoned as talesmen. The following jurors were sworn: (Give the list.) The following witnesses were sworn for the plaintiff: (Note in order in the docket all exceptions taken to any testimony.) The following witnesses were sworn for the defendant, etc. The following witnesses were sworn in rebuttal, etc. (All exceptions to rulings of the court are to be noted in the docket in order whenever they occur.)

September 17, 5 P.M.--After hearing the testimony, the jury retire, under charge of Constable G.W., sworn for that purpose.

6 P.M.--Jury returned into court, and say that they find for the plaintiff for the sum of $86.00.

Judgment rendered thereupon against the defendant for $86.00 and costs of suit, taxed at $12.50, on this 17th day of September, 1887.

W.D.D., Justice of the Peace.

September 29, 1887.--Execution issued for $86.00, and interest from September 17, and for $12.50 costs, and delivered to Constable G.W. to collect.

W.D.D., Justice of the Peace.

October 11.--Execution returned satisfied.

W.D.D., Justice of the Peace.

October 15,1887.--Received the above judgment and costs in full.

J.T., Plaintiff.

OATH TO JURORS.

"You do solemnly swear that you will well and truly try the matters in difference between the parties in this cause, and a true verdict give, according to the evidence given you in court and the laws of this state. So help you God."

OATH TO WITNESS.

"You do solemnly swear that the evidence you shall give relative to the cause now under consideration shall be the whole truth, and nothing but the truth. So help you God."

OATH TO OFFICER.

"You do solemnly swear that you will keep this jury together in some suitable place, without food or drink, unless ordered by the court; that you will suffer no person to speak to them upon the matters submitted to their charge until they are agreed, nor will you speak to them yourself about the cause, except to ask them whether they are agreed; that you will permit no person to listen to, or overhear, any conversation or discussion they may have while deliberating on their verdict; that you will not disclose their verdict nor any conversation they may have respecting the cause, until they have delivered their verdict in court, or been discharged by order of the court. So help you God."

EXECUTION.

State of __________,} County of _________}ss.

The state of _________ to the sheriff or any constable of said county:

Whereas, judgment against A.M. for the sum of (eighty-six) dollars, lawful money of the United States, and for (twelve) dollars and (fifty) cents, costs of suit, was recovered the _____ day of _________, 18_____, before me, at the suit of J.T.; these are therefore to command you to levy distress on the goods and chattels of the said A.M. (excepting as the law exempts), and make sale thereof according to law, in such case made and provided, to the amount of the said sum, together with twenty-five cents for this execution, and the same return to me within thirty days, to be rendered to the said J.T. for his said judgment and costs. Hereof fail not, under penalty of the law.

W.D.D., Justice of the Peace

ENDORSEMENTS ON EXECUTION.

IN JUSTICE COURT

COUNTY OF.........................................

J.T., plaintiff

_against_

A.M., defendant

EXECUTION.

Collect Judgment........$86 00
Costs................... 12 00
______
$98 50

Interest thereon at seven per cent, from Sept. 17, 1887, and your fees.

W.D.D., Justice of the Peace

Received the within execution Sept. 29, 1887.

G.W., Constable.

(See constable's return.)

RETURN OF EXECUTION.

(_Venue_.)

By virtue of the within execution, on this first day of October, 1887, I have levied on one bay horse about seven years old, one single harness, and one single buggy, the property of the said A.M.

G.W., Constable.

CONSTABLE'S SALE.

(_Venue_.)

By virtue of an execution issued by E.M., justice of the peace, against the goods and chattels of A.M., I have seized and taken the following described property, to-wit: (describing it), which I shall expose for sale at public vendue to the highest bidder, on Tuesday, the eleventh day of October, 1887, at ten o'clock A.M. (in front of the postoffice), at _____, in said county.

G. W., Constable.

Dated Oct. 1, 1887.

FINAL RETURN.

(_Venue_.)

I hereby certify that, by virtue of the within execution, on the first day of October, 1887, I levied on the goods and chattels in the annexed inventory named, the property of said A.M., and on the first day of October, 1887, I advertised the said property for sale by posting up in three public places in the election district where it was to be sold, to-wit, in the town of _________, three notices describing said property, and giving notice of the time and place, when and where the same would be exposed for sale; that at the time so appointed (naming it), I attended at the place mentioned in said notice (naming the place), and then and there exposed the said goods and chattels to sale at public vendue to the highest bidder; and sold the said horse to John Smith, for $76; the harness to Edward White, for $13.50; and the buggy to Samuel Jones, for $23.40, they being the highest bidders therefor; that I have retained $4.16, my fees and disbursements, from said amount, and have applied $86.40 in payment of the within execution, Which is hereby returned fully satisfied.

G. W., Constable.

(Dated and signed.)

_II. Criminal Prosecutions._

OATH TO COMPLAINANT.

"You do solemnly swear that you will true answers make to such questions as shall be put to you touching this complaint against R.F. So help you God."

CRIMINAL COMPLAINT.

State of _________,} County of _______,}ss.

The complaint of J.D., of said county, made before A.J.S., Esq., one of the justices of the peace in and for said county, who, being duly sworn, on his oath says, that on the _____ day of _________, 18_____, at the _____ of _________, in said county, one R.F. did * threaten to beat (or wound, or maim, or as the case may be) him, the said J.D., and to do him great bodily harm; (or to burn his dwelling-house; or as the case may be); and that he has great cause for fear the said R.F. will beat, etc., (as above.) The said J.D., therefore, prays surety of the peace to be granted him against the said R.F., and this he does, not from any private malice or ill-will towards the said R.F., but simply because he is afraid, and has good cause to fear, that the said R.F. will beat, etc., (as above), against the form of the statute in such case made and provided, and against the peace and dignity of the state of Minnesota, * and prays that the said R.F. may be arrested and dealt with according to law.

J.D.

(_Jurat_.)

A.J.S., Justice of the Peace.

WARRANT.

State of _________,} County of _______,}ss.

The State of _________ to the sheriff or any constable of said county:

Whereas, J.D. has this day complained in writing to me, on oath, that R.F., on the _____ day of _________, 18_____, at _________ in said county, did (insert the statement of the offense, as in the complaint); and prayed that the said R.F. might be arrested and dealt with according to law; Now, therefore, you are commanded forthwith to apprehend the said R.F., and bring him before me, to be dealt with according to law; and you are also commanded to summon A.B., C.D., and E.F., material witnesses in said complaint, to appear and testify concerning the same.

Given under my hand this day of, A.D. 18_____.

A.J.S., Justice of the Peace.

RETURN ON WARRANT.

(_Venue_.)

I hereby certify that by virtue of the within warrant I have arrested the within named defendant, and have him now before the court in custody.

(Fees, etc.)

(Dated.)

J.N., Constable.

RECOGNIZANCE.

State of _________,} County of _______,}ss.

We, R.F., as principal, and J.B. and L.O., as sureties, of _________, in said county, acknowledge ourselves to owe and be indebted unto the state of Minnesota in the sum of (two hundred) dollars, to be levied of our several goods and chattels, lands and tenements, to the use of said state, if default be made in the condition following, to-wit:

The condition of this recognizance is such, that if the above bounden R.F. shall and does keep the peace, and be of good behavior, for the period of (three months) from the date hereof, towards all the people of this state, and particularly towards J.D., then this recognizance to be void; otherwise of force.

R.F.

J.B.

L.O.

Taken and acknowledged before me, etc.

A.J.S., Justice of the Peace.

COMMITMENT.

State of _________,} County of _______,}ss.

The State of _________ to the sheriff or any constable, and to the keeper of the common jail of said county:

Whereas, B.F. was, on the _____ day of _________, 18_____, brought before the undersigned, one of the justices of the peace in and for said county, charged, on the oath of J.D., with having, on the _____ day of _________, 18_____, at _____, in the said county (here state the offense as charged in the warrant), and upon examination of the said charge, it appearing to me that there is just cause to fear that such offense will be committed by the said R.F., he was ordered to enter into a recognizance, with sufficient sureties in the sum of ($200), to keep the peace toward all the people of this state, and especially toward the said J.D., for the term of (three) months; and the said R.F. having refused (or failed, or neglected,) to comply with such order: Now, therefore, you, the said constable, are commanded forthwith to convey and deliver into the custody of the said keeper the body of the said R.F., and you, the said keeper, are hereby commanded to receive the said R.F. into your custody in the said jail, and him there safely kept for the term of (three) months from the date hereof, or until he so recognizes as aforesaid, or until he shall thence be discharged by due course of law.

Given under my hand this _____ day of _________, A.D. 18_____.

J.P., Justice of the Peace.

JAILER'S RECEIPT.

(_Venue_.)

I hereby certify that I have received into my custody the within named R.F., and have lodged him in the common jail of said county, as within commanded.

Dated, etc.

L.S.P., Sheriff, by G.S., Deputy.

CONSTABLE'S RETURN.

(_Venue_.)

I hereby certify that by virtue of the within warrant I have delivered the within named R.F. to the keeper of the common jail of the said county, as appears by his receipt indorsed hereon.

Dated, etc. T.R., Constable.

Fees, etc.

_III. Miscellaneous._

COMPLAINT FOR SEARCH WARRANT.

(Follow form "Criminal Complaint" to the *, then say): Divers goods and chattels, viz.: (describing them particularly, and their value,) were feloniously stolen, taken and carried away; and that the said C.W. has good reason to believe, and does believe, that the said goods and chattels are concealed in the (dwelling-house) of one J.S., situated in the (town) of _________, in said county (particularly describing the place), and that the grounds of his said belief are as follows: (here state the facts and circumstances on which his belief is founded.) He, therefore, prays that a warrant may issue to make search for said goods and chattels in said (dwelling-house) of the said J.S., according to the statute in such case made and provided.

C.W.

(_Jurat_.)

SEARCH WARRANT.

(Use the general form of warrant, except in the concluding sentence say): Now, therefore, you are commanded forthwith to enter the (dwelling-house) of one J.S., situated, etc., (particularly describing the place), and there make search for the above described property (or, as the case may be); and if the same, or any part thereof, shall there be found, you are hereby commanded to bring the same, together with the person(s) in whose possession the same may be found, before me, to be dealt with according to law.

Given under my hand, etc.

A.J.S., Justice of the Peace.

_Probate Court._

PETITION FOR ADMISSION OF WILL.

State of _________,} County of _______,}ss.

In Probate Court.

To the Judge of said Court:

The petition of _________ of said _________, respectfully represents that _________ late of _________, deceased the _____ day of _________, at _____, died testate, as petitioner believe; that the instrument in writing herewith presented to this court, is the last will and testament of said deceased as petitioner believe; and that _________ the said petitioner _________ the identical _________ named and appointed in and by said last will and testament as executor thereof; that the heirs at law of said deceased are _________.

Your petitioner would further represent, that the goods, chattels and personal estate of said deceased amount to about _____ dollars; and that the said deceased left debts due and unpaid to the probable amount of _____ dollars.

Your petitioner would pray that a day be appointed for hearing the proofs of said last will and testament, and that public notice thereof be given to all persons interested, as this court shall direct; and that upon the proof and allowance of said will, and the approval of the bond of your petitioner _________, letters testamentary be to _________ issued thereon, and appraisers and commissioners appointed, according to the rules and practices of this court.

Dated at _____, this _____ day of _____, A.D. 18_____.

State of _________,} County of _______,}ss.

On this day of _____, A.D. 18_____, before me personally appeared the above named _____ and made oath that _____ he heard read the above and foregoing petition, subscribed by _____ and know the contents thereof, and that the same is true of _____ own knowledge, except as to the matters which are therein stated to be on _____ information and belief, and as to those matters he believe it to be true.

ORDER ADMITTING WILL.

State of _________,} County of _______,}ss.

In Probate Court. Term _____, 18_____

In the matter of the estate of _____, deceased.

Pursuant to an order of this court made in the above entitled matter, on the _____ day of _____, 18_____, the hearing of the proofs of that certain instrument bearing date the _____ day of _____, 18_____, purporting to be the last will and testament of _____, deceased, came on this day; and it appearing to the satisfaction of the court that the notice directed in the order aforesaid to be given, has been given; thereupon _____ and _____, the subscribing witnesses to said instrument, were duly sworn and examined on behalf of the proponent thereof, their testimony reduced to writing, subscribed by them, and filed. And it appearing to the court after a full hearing and examination of the testimony in said matter, that said _____ died on the _____ day of _____, 18_____, testate, in the said county of _____, and that he was at the time of his death a resident of said county, and left assets therein; that said instrument offered for probate as and for the last will and testament of said deceased, was duly executed as his last will and testament by said testator according to law; that said testator, at the time of executing the same, was of sound mind, of lawful age and under no restraint, and that the same is valid and genuine; and no adverse appearance or objection being made:

Now, therefore, it is ordered, adjudged, and decreed, that said instrument be and hereby is established and allowed as the last will and testament of said _____, deceased, and that the same hereby is admitted to probate. Ordered, further, that said last will and testament, with a certificate of the probate thereof, be recorded.

Judge of Probate.

CERTIFICATE OF PROOF OF WILL.

State of _______,} County of ______}

In Probate Court.

In the matter of the estate of _____, deceased:

Be it remembered, that on the day of the date hereof, at a _____ term of said probate court, pursuant to notice duly given, the last will and testament of _____, late of said county of _____, deceased, bearing date the _____ day of_____, 18_____, and being the annexed written instrument, was duly proved before the probate court in and for the county of aforesaid; and was duly allowed and admitted to probate by said court according to law, as and for the last will and testament of said _________, deceased, which said last will and testament is recorded and the examination taken thereon filed in this office.

In testimony whereof, the judge of the probate court of said county hath hereunto set his hand and affixed the seal of the said court, at _____ in said county, this _____ day of _________, A.D. 18_____

Judge of Probate.

LETTERS TESTAMENTARY.

State of _______,} County of ______}ss

The State of _______, to all to whom these presents shall come or may concern, and especially to _______ of the county of _______ and state of _______, greeting:

Know ye, that whereas, _______ late of the county of _______ and state of _______, lately died testate, and being at the time of his decease a _______ of said county, by means whereof the proving and recording his last will and testament, and granting administration of all and singular the goods, chattels, rights, credits and estate whereof he died possessed, and also the auditing, allowing and finally discharging the account thereof, is within the jurisdiction of the probate court of said county of _______.

And whereas, on the _____ day of _______, A.D. 18_____, at _______ in said county, before the Hon. _______, probate judge of said county, the last will and testament of the said _______ (a copy whereof is hereunto annexed) was proved, allowed and admitted to probate: And, whereas, _______, executor named and appointed in and by said last will and testament, has given bond, as required by law, for the faithful execution of said trust, which said bond has been approved by said judge, and filed in the aforesaid probate court; we therefore, reposing full confidence in your integrity and ability, have granted and by these presents do grant the administration of all and singular the goods, chattels, rights, credits and estate of the said deceased, and any way concerning his said last will and testament, unto you, the said _______ executor aforesaid: Hereby authorizing and empowering you to take and have possession of all the real and personal estate of said deceased, and to receive the rents, issues and profits thereof, until said estate shall have been settled, or until delivered over by order of said court, to the heirs or devisees of said deceased; and to demand, collect, recover and receive all and singular, the debts, claims, demands, rights, and chooses in action, which to the said deceased while living and at the time of his death did belong; and requiring you to keep in good tenantable repair, all houses, buildings and fences on said real estate, which may and shall be under your control, and in accordance with your bond approved and filed as aforesaid, to make and return into the probate court of said county of _______ within three months, a true and perfect inventory of all the goods, chattels, rights, credits and estate of said deceased, which shall come to your possession or knowledge, or to the possession of any other person for you; to administer, according to law, and to said last will and testament, all the goods, chattels, rights, credits and estate of the said deceased, which shall at any time come to your possession or to the possession of any other person for you, and out of the same to pay and discharge all debts, legacies and charges chargeable on the same, or such dividends thereon as shall be ordered and decreed by said court; to render a just and true account of your administration to said court within one year, and at any other time when required by said court, and to perform all orders and decrees of said court, by you to be performed in the premises.

In testimony whereof, we have caused the seal of our probate court to be hereunto affixed: Witness the Hon. _______, judge of probate, at _______, in said county, this _____ day of _______, A.D. 18_____.

Judge of Probate Court, County of _______, _______.

FORM OF WILL.

I, (name of testator), of (residence), being of sound mind and memory, do hereby make, publish, and declare this to be my last will and testament, hereby revoking and making void all former wills by me at any time heretofore made.

First.--I order and direct my executors, as soon after my death as possible, to pay off and discharge all debts and liabilities that may exist against me at the time of my decease.

Second.--I give and bequeath unto my wife, (naming her, and specifying property bequeathed.)

Third.--I give and bequeath unto my son, (naming him, and specifying property bequeathed.)

And so on for each legacy.

Fourth.--I hereby nominate and appoint (naming the person or persons) as the executors of this, my last will and testament.

In witness whereof, I have hereunto subscribed my name, this day of _______, A.D. _______ Autograph signature of testator.

The above and foregoing instrument was at the date thereof signed, sealed, published, and declared, by the said (name of testator), as and for his last will and testament, in presence of us, who, at his request, and in his presence, and in the presence of each other, have subscribed our names as witnesses.

Name _______, Residence. Name _______, Residence.

For citations, pupils should watch the newspapers and make clippings.

_District Court_.

HABEAS CORPUS.

State of _______,} County of ______}ss

District Court, Judicial District.

The State of ________ to

You are hereby commanded to have the body of ________, by you imprisoned and detained, as it is said, together with the time and cause of such imprisonment and detention, by whatsoever name the said ________ shall be called or charged, before the Honorable ________, judge of the district court, ________ to do and receive what shall then and there be considered concerning the said ________. And have you then and there this writ.

Witness the Honorable ________, judge of said district court, at ________ in said county, this _____ day of ________, A.D. 18_____.

________ Clerk.

INDICTMENT.

State of _______,} County of ______}ss

District Court, Judicial District.

The State of ________ against ________, accused by the grand jury of the county of ________, in the state of ________, by this indictment of the crime of ________, committed as follows:

The said ________, on the _____ day of ________, A.D. 18_____, at the city of ________, in the county of ________, and state of ________, did, without the authority of law, and with malice aforethought, ________, contrary to the form of the statute in such case made and provided, and against the peace and dignity of the state of ________.

Dated at the city of ________, in the county of ________, and state of ________, this _____ day of ________, A.D. 18_____.

A.L.H., Foreman of the Grand Jury.

Names of witnesses examined before the grand jury: B.F.H., R.D.H., A.F.B., E.S., H.P.C., L.H.

NATURALIZATION PAPERS.

(_First Paper_.)

State of _______,} County of ______}ss

I, ________, do solemnly declare on oath to ________, clerk of the district court of the county of ________, and state of ________, that it is bona fide my intention to become a citizen of the United States, and to renounce forever all allegiance and fidelity to any foreign prince, potentate, state or sovereignty whatever, and particularly to the sovereign of ________, whereof I was heretofore a citizen or subject.

(Signed.)

Subscribed and sworn to before me this _____ day of _______, A.D. 18__.

Clerk of said Court.

State of _______,} County of ______}ss

I hereby certify that the foregoing is a true copy of the original declaration of _______, this day filed in my office.

In testimony whereof, I have hereunto subscribed my name and affixed the seal of the district court aforesaid, at _______, this ____ day of _______, A.D. 18__.

Clerk.

(Second Paper.)

State of _______,} County of ______}ss

District Court, Judicial District.

Be it remembered, that on this ____ day of _______, 18__, _______ appeared in the district court of the _____ judicial district of the State of _______, and for the county aforesaid, the said court being a court of record, having a common law jurisdiction and a clerk and seal, and applied to said court to be admitted to become a citizen of the United States of America, pursuant to the several acts of congress of the United States of America for that purpose made and provided; and the said applicant having thereupon produced to the court such evidence, declaration and renunciation, and having taken such oaths as are by the said acts required: Thereupon it was ordered by the said court that the said applicant be admitted, and he was accordingly admitted by the said court to be a citizen of the United States of America.

In testimony whereof, I have hereunto subscribed my name and affixed the seal of the court aforesaid, this ____ day of _______, A.D. 18__.

Clerk of said Court.

SATISFACTION OF JUDGMENT.

State of _______,} County of ______}ss

District Court, Judicial District.

(_Title of Cause._)

The judgment in the above entitled action, rendered in _______ county, _______, on the ____ day of _______, A.D. 18__, and duly docketed in the office of the clerk of the district court of said county, on the ____ day of _______, A.D. 18__, for $____ in favor of _______ against _______, is paid and satisfied in full; and the clerk of said court is hereby authorized to discharge said judgment of record.

In testimony whereof, _______ has hereunto set _____ hand and seal this ____ day of _______, A.D. 18__.

Signed, sealed and delivered in presence of _______

[Seal.] [Seal.] [Seal.]

State of _______,} County of ______}ss

On this ____ day of _______, A.D. 18__, before me, the subscriber, a _______ in and for said county, personally appeared _______ to me known to be the person described in, and who executed the foregoing instrument, and acknowledged that he executed the same as _______ free act and deed.