IN THE CHANCERY COURT FOR THE TWENTIETH JUDICIAL DISTRICT DAVIDSON COUNTY, TENNESSEE __________________________________ PLAINTIFF vs. NO. ____________________ __________________________________ DEFENDANT STATE OF TENNESSEE DAVIDSON COUNTY WRIT OF CERTIORARI WHEREAS, ______________________________________________________ __________________________, has filed a Complaint/Petition for Writ of Certiorari duly sworn against the Board/Department decisions in the Board/Department Case No. ______________, you are hereby commanded pursuant to T.C.A. 27-9-109 to cause to be made, certified and forwarded to the Clerk and Master of this court a complete transcript and record of the proceedings in the Board/Department case No. _________________, containing all exhibits and proof submitted before the Board and all entries made in connection therewith, including the transcript of the hearing before the Board on ____________, and any proceedings before the Board/Department relating to Case No. ________________. This ______ day of ________, 20 ___. __________________________________________ CHANCELLOR/DEPUTY CLERK AND MASTER ADA Coordinator, Cristi Scott (862-5710) American LegalNet, Inc. www.USCourtForms.com