for Recovery of Fine
section 421 Criminal Procedure Code)
the Collector of the district of.................
(name, address and description of the offender) was on the day of, 19,
convicted before me of the offence of (mention the offence concisely), and
sentenced to pay a fine of rupees; and
the said (name), although required to pay the said fine, has not paid the same
or any part thereof;
are hereby authorised and requested to realize the amount of the said fine as
arrears of land revenue from the movable or immovable property, or both, of the
said (name) and to certify without delay what you may have done in pursuance of
this ...............day of...........19.
of the Court) (Signature)