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‘WE, the Copyhold Commissioners, do hereby certify, That the Land mentioned in the Schedule to this Certificate is charged with the Payment to A.B., his Executors, Administrators, or Assigns, [or “to the Lord of the Manor of for the Time being,” as the Case may be,] of the following Series of periodical Payments; that is to say, the Sum of £ payable on the Day of A.D.; the further Sum of £ payable on the Day of A.D.&c. [or “with the Principal Sum of £ with Interest thereon after the Rate per Centum per Annum, the Principal “to be repayable in manner following; that is to say,” state the Terms]; and we do further certify that this Certificate of Charge was made in respect of Consideration Money [or in respect of Expenses]; and further, that after Payment of the Series of periodical Payments above mentioned [or after Payment of the Principal Money hereby charged, and all Arrears of Interest due thereon,] this Certificate shall be void. In witness whereof we have hereunto set our Hands and the Seal of the said Commissioners, this Day of A.D. 18.
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