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I, Steward of the Barmote Courts for the Soke and Wapentake of Wirksworth [orLiberty of ], do hereby, by virtue of the “Derbyshire Mining Customs and Mineral Courts Act 1852,” impose onC.D. the Sum of£ as a Penalty for an Offence by him committed against the said Act, and I order him to pay the said Sum to on or before the Day of in the Year of our Lord 185 .
Given under the Seal of the Court, this Day of 185 .
E.F.,Steward.