IN THE CHANCERY COURT FOR KNOX COUNTY, TENNESSEE : Address: S.S. # Docket No. vs. TCSES No. : Address: S.S. # IN RE: (Children) Name: D.O.B. Name: D.O.B. Name: D.O.B. PETITION FOR CONTEMPT FOR NON-PAYMENT OF CHILD SUPPORT COMES NOW the Petitioner and states: 1. That the Respondent was ordered by this Court to pay child support to in the amount of $ per (weekly, bi-weekly, monthly, bi-monthly). 2. That the Respondent has willfully failed and refused to obey the Orders of this Court in that the Respondent has: 3. That the Respondent is well and able to obey the Orders of this Court and has failed to do so and is in civil contempt of this Court. WHEREFORE, THE PETITIONER PRAYS: 1. That process issue and be served upon the Respondent requiring him or her to answer, with oath waived; 2. That this Court find the Respondent to be in willful contempt and punish the Respondent accordingly; American LegalNet, Inc. www.FormsWorkFlow.com 3. That the costs in this cause be taxed to the Respondent; and 4. That the Petitioner have such further general relief as may be justified. Signature of Petitioner Sworn to and subscribed before me this day of , 20 . CLERK NOTICE OF HEARING Please take note that this Petition for Contempt is set for 9:00 a.m. on the day of , 20 , before Referee Brenda Lindsay - McDaniel, Old Knoxville Courthouse, Courtroom 327, 3rd Floor, Knoxville, Tennessee 37902. COST BOND I, as Principal , and as Surety, are held firmly bound unto the Clerk and Master, Knox County Chancery Court, for the payment of all costs awarded against the Principal. To t hat end, we bind ourselves, our heirs, executors and administrators. The Principal is commencing legal proceedings in the Chance ry Division of Knox County Chanc ery Court. If the Principal shall pay all costs adjudged against them, then this obligati on is void. If the Principal fail s to pay such costs, then the Surety shall undertake to pay all costs a djudged against the Principal . Mandated at T.C.A. 247 20 - 12 - 120 et seq . Signature of Principal Signature of Surety PRINCIPAL : SURETY: (Print Name) (Print Name) Social Security Num ber: Address : Address: Employer: American LegalNet, Inc. www.FormsWorkFlow.com