CIRCUIT COURT SUMMONS NASHVILLE, TENNESSEE STATE OF TENNESSEE DAVIDSON COUNTY TH 20 JUDICIAL DISTRICT CIVIL ACTION DOCKET NO. First Alias Pluries Plaintiff Vs. Method of Service: Davidson County Sheriff Out of County Sheriff Secretary of State Certified Mail Personal Service Commissioner of Insurance Defendant To the above named Defendant: You are summoned to appear and defend a civil action filed against you in the Circuit Court, 1 Public Square, Room 302, P.O. Box 196303, Nashville, TN 37219-6303, and your defense must be made within thirty (30) days from the date this summons is served upon you. You are further directed to file your defense with the Clerk of the Court and send a copy to the Plaintiff's attorney at the address listed below. In case of your failure to defend this action by the above date, judgment by default will be rendered against you for the relief demanded in the complaint. RICHARD R. ROOKER ISSUED: _____________________ By: Deputy Clerk Circuit Court Clerk Davidson County, Tennessee ATTORNEY FOR PLAINTIFF or Address PLAINTIFF'S ADDRESS TO THE SHERIFF: Please execute this summons and make your return hereon as provided by law. RICHARD R. ROOKER Circuit Court Clerk Received this summons for service this _________ day of ________________, 20____. __________________________________ SHERIFF To request an ADA accommodation, please contact Dart Gore at (615) 880-3309. American LegalNet, Inc. www.FormsWorkFlow.com RETURN ON PERSONAL SERVICE OF SUMMONS I hereby certify and return that on the _____________ day of _____________________________________, 20______, I: served this summons and complaint/petition on in the following manner: failed to serve this summons within 90 days after its issuance because Sheriff/Process Server 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 Docket No. to the defendant, , 20 on the . On the day of , I received the return receipt for said registered or certified mail, which had been signed day of , 20 . Said return by receipt is attached to this original summons and both documents are being sent herewith to the Circuit Court Clerk for filing. SWORN TO AND SUBSCRIBED BEFORE ME ON THIS ________ DAY OF ______________________, 20_____. _______________________________________________ ________NOTARY PUBLIC or ________DEPUTY CLERK MY COMMISSION EXPIRES: ______________________ PLAINTIFF, PLAINTIFF'S ATTORNEY OR OTHER PERSON AUTHORIZED BY STATUTE TO SERVE PROCESS NOTICE TO THE DEFENDANT(S): Tennessee law provides a ten thousand dollar ($10,000.00) debtor's equity interest 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 items 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. ATTACH RETURN RECEIPT HERE (IF APPLICABLE) STATE OF TENNESSEE COUNTY OF DAVIDSON (To be completed only if copy certification required.) I, Richard R. Rooker, Clerk of the Circuit Court in the State and County aforesaid, do hereby certify this to be a true and correct copy of the original summons issued in this case. RICHARD R. ROOKER, CLERK By: _________________________________________D.C. American LegalNet, Inc. www.FormsWorkFlow.com