STATE OF TENNESSEE, COUNTY OF MADISON To Any Lawful Officer To Execute and Return: Summon To appear before the General Sessions Court of Madison, County, Tennessee. To be held in the General Sessions Court Room, on the 3rd Floor of the Criminal Justice Complex, at 515 South Liberty Street, Madison County, Jackson, Tennessee on the day of , 20 at p.m./a.m., then and there to answer in a civil action brought by for Under $ Judgment for Against For $ plus interest at the rate of % and cost of suit, for which execution may issue. Judgment entered by: Default Agreement Trial Dismissed: Without Prejudice With Prejudice Costs taxed to: Plaintiff Defendant Defendant(s) in court and admitted to jurisdiction of court. This the day of , 20. , Judge Division This the day of , 20 . , Judge Case No. Plaintiff Address City State Zip Phone vs. Defendant Address City State Zip Defendant Address City State Zip CIVIL SUMMONS Court of General Sessions Kathy Blount, Clerk By , Deputy Clerk Issued , 20. Set for at . Reset for Served Upon All Named Defendants All Defendants Except: Served , 20. Sheiff/Constable (Process Server) Attorney for Plaintiff Telephone Attorney for Defendant Telephone CIVIL SUMMONS JUDGMENT ORDER American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT To the best of my information and belief, after investigation of Defendant222s employment, I hereby make affidavit that the Defendant is/is not a member of a military service. Attorney for Plaintiff or Plaintiff Notary Public My Comm. Exp. TO THE DEFENDANT(S): Failure to appear and answer this Summons will result in judgment by default being rendered against your for the relief requested. Tennessee law provides a ten thousand dollar ($10,000) personal property exemption as well as a homestead exemption from execution or seizure to satisfy a judgment. If a judgment should be entered against you in this action and you with 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 become 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 items include items of necessary wearing apparel (clothing) for yourself and your family and trunks and 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 of how to execute it, you may wish to seek the counsel of a lawyer. American LegalNet, Inc. www.FormsWorkFlow.com