FORM 43 (Section 744)
Jailer’s Receipt to Peace Officer for Prisoner
I hereby certify that I have received from X.Y., a peace officer for (territorial division), one A.B., together with a (warrant or order) issued by (set out court or justice, as the case may be).
Add a statement of the condition of the prisoner
Dated this day of A.D. , at .
Keeper of (prison)