STATE OF TENNESSEE SHELBY COUNTY CHANCERY COURT PLAINTIFF SUBPOENA* ____ to testify ____ duces tecum ____ to take deposition DEFENDANT DOCKET NUMBER CH- ___________________ TO: (Name, Address & Telephone Number of Witness) Method of Service: ____ Shelby County Sheriff ____ Out of County Sheriff ____ Private Process Server *You are hereby commanded to appear at the time, date and place specified for the purpose of giving testimony. In addition, if indicated, you are to bring the items listed. Failure to appear may result in punishment by fine and/or imprisonment as provided by law. TIME TO APPEAR DATE TO APPEAR ITEMS TO BRING: PLACE TO APPEAR: Chancery Court, Part ________ 140 Adams Ave. Third Floor Memphis, Tennessee 38103 -OR- ___ Additional List Attached This subpoena is being issued on behalf of ____ Plaintiff ____ Defendant DATE ISSUED Attorney: (Name, Address & Telephone Number) Donna L. Russell, Clerk and Master ATTORNEY’S SIGNATURE: _______________________________________ By: ______________________________________ Deputy Clerk and Master Private Process Server’s Name, Address and Phone No. RETURN ON SERVICE Check one: Note: A Private Process Server’s or an Attorney’s return must be sworn to below. 1. ___ I certify that on _____________________________________ I served a copy of this subpoena on the witness stated above by ______________________________________________________________________________________________________________ 2. ___ I certify that on _____________________________________ I failed to serve a copy of this subpoena on the witness because ______________________________________________________________________________________________________________ Notes or Signature of recipient (Optional): Sworn to and subscribed before me on this _______ day of _______________________, 20 _____. ________________________________________________ Notary Public / Deputy Court Clerk ___________________________________________________________ Signature of Sheriff, Attorney or Attorney’s Agent My Commission Expires: __________________________ For disability assistance only-901-379-7895 Revised 07/10/07 American LegalNet, Inc. www.FormsWorkFlow.com