IN THE NAME OF THE GOD-EMPEROR OF MANKIND, THE PRESERVER OF HUMANITY, AND THE ETERNAL LORD OF TERRA, FOREVER BLESSED BE HIS NAME:

In accordance with the will of the God-Emperor, Lectitio Divinitatus, and the Codex Hereticorum, the Ordo Hereticus of the Imperial Inquisition hereby indicts and summarily pronounces guilty of Heresy the ___________ on the following charges:

I. Endorsement of Heretical Doctrine HD.___: "___."

II. CH.__: "_______."

III. CH.__

Signed,

Fyodor Karamazov,
Inquisitor Lord and Pyrophant Judge of Salem Proctor