C. D......, speaking as aforesaid

That, by a deed of lease, executed on the.…., before... , notary, the said A. B..... , did

lease to the said C. D....., for the term of...., a house, etc., (description) ; the whole on condition of using and enjoying the same in a proper and husbandlike manner.

That the said OC. D... , bath, through his fault and negligence, caused to the said house and premises the following damages and deteriorations : (give the details); the whole in contravention to the stipulations contained in the said deed of lease, and to the great prejudice of the said À. B....…

Wherefore, I have, at the said request, protested as I do, by these presents, most solemnly protest, etc., (as in the preceding forms).

And I have moreover, at the said request, summoned and required the said C. D...

speaking as aforesaid, to cause to be repaired immediately and without any delay the said

damages an deteriorations, by... , (give a detail of the repairs required).

To all which the said... made answer,

(insert the answer) and he hath signed (or :

refused to sign), by me duly requested so to do ; and I have consequently persisted in the said summons and protestations.

Done and signified, etc.