(See section 524)
Summons To An Accused Person
(See section 63)
To (name of accused) of (address)
WHEREAS your attendance is necessary to answer to a charge of (state shortly the offence charged), you are hereby required to appear in person (or by pleader, as the case may be) before the (Magistrate) of , on the day . Herein fail not.
Dated, this day of , 20 .
(Seal of the Court)
(Signature)