Section 5. If the imprisonment or restraint is not by a sheriff, deputy sheriff or jailer, the writ shall be in the following form:

Commonwealth of Massachusetts.

(Seal.) To the sheriffs of our several counties and to their respective deputies,

Greeting.

We command you that the body of           , of
         , by          , of          ,
imprisoned and restrained of his liberty, as it is said, you take and
have before           a justice of our supreme judicial court at              immediately after the receipt of this writ, to do and receive what our said justice shall then and there consider concerning him in this behalf; and summon said           then and there to appear before our said justice to show the cause of the taking and detaining of said           ; and have you there this writ with your doings thereon.

Witness        at        this        day
of        in the year      .