STATE OF TENNESSEE THE CIRCUIT COURT FOR KNOX COUNTY SUMMONS PLAINTIFF ) vs. CIVIL ACTION NO. DEFENDANT ) To the above named defendant (s): You are hereby summoned and required to serve upon , plaintiff / plaintiff325s attorney, whose address is , an answer to the complaint herewith served upon you within 30 days after service of this summons and complaint upon you, exclusive of the day of service. A copy of the answer must be filed with the court either before or within a reasonable time after service. If you fail to do so, judgment by default can be taken against you for the relief demanded in the complaint. Issued and attested this the day of , . Charles D. Susano III, Clerk Deputy Clerk NOTICE To the defendant (s): Tennessee law provides a Ten Thousand dollar ($10,000) 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 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 counsel of a lawyer. American LegalNet, Inc. www.FormsWorkFlow.com SERVICE INFORMATION To the process server: Defendant can be served at: RETURN I received this summons on the day of , . I hereby certify and return that on the day of , . I: [ ] served this summons and complaint on the defendant in the following manner: . [ ] failed to serve this summons within 30 days after its issuance because: . Process Server (Required to be filled out by Process Server) Name (please print): Address: American LegalNet, Inc. www.FormsWorkFlow.com The Americans with Disabilities Act prohibits discrimination against any qualified individual with a disability. The Tennessee Judicial Branch does not permit discrimination against any individual on the basis of physical or mental disability in accessing its judicial programs. In accordance with the Americans with Disabilities Act, if necessary, the Tennessee Judicial Branch will provide reasonable modifications in order to access all of its programs, services and activities to qualified individuals with disabilities. If you require a modification to access the judicial program and/or have special needs because of a qualified disability, you must submit a written Request for Modification to the Local Judicial Program ADA Coordinator listed below at least five (5) business days prior to the date of the judicial proceeding, if possible. A form is available from the Local Judicial Program ADA Coordinator or from the Tennessee Judicial Program ADA Coordinator (www.tncourts.gov) If you need assistance, have questions or need additional information, please contact the Local Judicial Program ADA Coordinator: ADA Compliance Officer Knox County Human Resources Office Suite 360, City-County Building 400 Main Street, Knoxville, Tennessee 37902 Voice Phone: (865) 215-2952 TTY: (865) 215-2497 If you need assistance, have questions or need additional information, you may also contact the Tennessee Judicial Program ADA Coordinator: ADACoordinator State Judicial ADA Program Administrative Office of the Courts Nashville City Center Suite 600, 511 Union Street Nashville, Tennessee 37219 Telephone (615) 741-2687 FAX: (615)741-6285 The Tennessee Judicial Branch325s Americans with Disabilities Act Policy regarding access to judicial program, as well as a Request for Modification form may be found online at www.tncourts.gov. American LegalNet, Inc. www.FormsWorkFlow.com