IN THE CHANCERY COURT FOR KNOX COUNTY, TENNESSEE (CHANCERY OR PROBATE DIVISION) , PLAINTIFF v. Case No. , DEFENDANT. IN RE: ESTATE OF , Case No. DECEASED. RULE 10 CERTIFICATION Pursuant to Rule 10 of the Local Rules of Practice, Knox County Chancery Court, I/We hereby certify as follows: (1) Party taxed with or obligated to pay costs: . (2) Current Phone Number: Current Address: . Current Email: . (3) Current Employer of Party: . Employers Address: . (4) Other information available to assist Clerk and Master in the collection of costs: . The undersigned certify(ies) that the above is true, correct and current and understands that the information is given to assist in the collection of court costs and to avoid the necessity of the clerk filing an execution or a motion to re-tax costs to principal(s) or surety(ies) under obligations to pay costs or existing cost bonds if costs are not paid promptly. This the day of , 20 . Signature and Title Signature and Title Printed Name and Title Printed Name and Title American LegalNet, Inc. www.FormsWorkFlow.com