STATE OF TENNESSEE SUMMONS IN THE CHANCERY COURT FOR WILLIAMSON COUNTY, TENNESSEE CIVIL ACTION NO. _______ Plaintiff Plaintiff vs. Defendant Service By: Sheriff Attorney Sec. Of State Comm. Of Insurance Defendant Defendant To the above named Defendant: You are hereby summoned and required to serve upon plaintiff's attorney, whose address is , an answer to the complaint which is herewith served upon you within thirty (30) days after service of this summons upon you, exclusive of the day of service. If you fail to do so, judgment by default will be taken against you for the relief demanded in the complaint. Witnessed and issued, Elaine B. Beeler, Clerk and Master for said Court at office this ___ day of ________, 20___. Clerk & Master NOTICE: To the defendant(s): Tennessee law provides a ten thousand dollar ($10,000.00) personal property exemption from execution or seizure to satisfy a judgment. If a judgment should be entered against you in this action and you wish to claim property as exempt, you must file a written list, under oath, of the terms you wish to claim as exempt with the clerk of the court. The list may be filed at any time and may be changed by you thereafter as necessary; however, unless it is filed before the judgment becomes final, it will not be effective as to any execution or garnishment issued prior to the filing of the list. Certain items are automatically exempt by law and do not need to be listed; these include items of necessary wearing apparel (clothing) for yourself and your family and trunks or other receptacles necessary to contain such apparel, family portraits, the family Bible, and school books. Should any of these items be seized, you would have the right to recover them. If you do not understand your exemption right or how to exercise it, you may wish to seek the counsel of a lawyer. Mail list, including docket number, to: Clerk and Master, P.O.Box 1666, Franklin, TN 37065. American LegalNet, Inc. www.FormsWorkFlow.com RETURN ON PERSONAL SERVICE OF SUMMONS I hereby certify and return that I served this summons together with the complaint as follows: Check one: (1) or (2) are for the return of an authorized officer or attorney; an attorney's return must be sworn to; (3) is for the witness who will acknowledge service and requires the witness's signature. 1. I certify that on the date indicated below I served a copy of this summons on the witness stated above by ______________________________________________________________ 2. I failed to serve a copy of this summons on the witness because ______________________________________________________________________________________ 3. I acknowledge being served with this summons on the date indicated below: DATE OF SERVICE: SIGNATURE OF WITNESS, OFFICER OR ATTORNEY: Signature of Notary Public or Deputy Clerk: Commission Expires: RETURN ON SERVICE OF SUMMONS BY MAIL I hereby certify and return that on the ______ day of _______________________, 20______, I sent, postage prepaid, by registered return receipt mail or certified return receipt mail, a certified copy of the summons and a copy of the complaint in case no. ____________________ to the defendant _________________________________, on the ______ day of ______________________, 20______. I received the return receipt, which had been signed by ____________________________________ on the ______ day of _______________________, 20______. The return receipt is attached to this original summons to be filed by the Chancery Court Clerk and Master. _____________________________________ Signature Sworn to and subscribed before me on this __ day of _____ 20____. _____________________________________ Signature of Notary Public or Deputy Clerk Commission Expires: _______ CERTIFICATION (IF APPLICABLE) I hereby certify this to be a true and correct copy of the original summons issued in this case. CLERK & MASTER For ADA assistance, please call ADA coordinator: 615-790-5428 American LegalNet, Inc. www.FormsWorkFlow.com