STATE OF TENNESSEE SHELBY COUNTY CHANCERY COURT State of Tennessee CAPIAS/BENCH WARRANT DOCKET NUMBER VS. Defendant_________________________________________________________________________________ Address __________________________________________________________________________________ SS# __________________________, Phone # ___________________________________ Sex ______ Race _____ DOB __________________ HT ______ WT ______ Eyes ________ Hair ________ Bond Amount: $ __________________, by _____ Cash or _____ Bail Bond Initial Appearance Date: _________________________ at ______: _____, _____. M. To the Sheriff of Shelby County, Tennessee You are hereby commanded to take the body of ____________________________________, if to be found in your County, and keep him/her safely, so that you have him/her before the Chancellor of Chancery Court, Part _____ for the County of Shelby, at the Shelby County Courthouse in Memphis, Instanter, and then and there to charge(s) of: _____________________________________________________________________ ______________________________________________________________________________________. Issued: ________________ ___________________________________ Chancellor SHERIFF’S RETURN: Came to hand on ______________________ and executed by: 1. _____ I hereby certify and return that on the below date I executed this Warrant by the arrest of: ______________________________________________________________________________________ 2. _____ I hereby certify that I have not served this Warrant because: _______________________________________________________________________________________ _______________________________________________________________________________________ Date of execution/Return _________________________ Bill Oldham, Sheriff by ______________________________ Deputy Sheriff Form W0-07/04 American LegalNet, Inc. www.FormsWorkFlow.com