CHANCERY COURT OF TENNESSEE 140 ADAMS AVENUE MEMPHIS, TENNESSEE 38103 FOR THE THIRTIETH JUDICIAL DISTRICT AT MEMPHIS SUMMONS IN CIVIL ACTION AD DAMNUM $ AUTO NO. VS OTHER Home Address PLAINTIFF Business Address Home Address DEFENDANT Business Address TO THE DEFENDANT(S): You are hereby summoned and required to defend a civil action by filing your answer with the Clerk of the Court and serving a copy of your answer to the Complaint on Plaintiff's attorney, whose address is: within THIRTY (30) DAYS after this summons has been served upon you, not including the day of service. If you fail to do so, a judgment by default may be taken against you for the relief demanded in the Complaint. KENNY W. ARMSTRONG, Clerk and Master ATTESTED AND ISSUED By D.C. TO THE DEFENDANT(S): NOTICE: Pursuant to Chapter 919 of the Public Acts of 1980, you are hereby given the following Tennessee law provides a four thousand dollar ($4,000.00) 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 with 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 (clothing) 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 the counsel of a lawyer. COST BOND I hereby acknowledge and bind myself for the prosecution of this action and payment of all costs not to exceed $500.00 in this court which may at any time be adjudged against the plaintiff in the event the said plaintiff shall not pay the same. Witness My hand this Certification when applicable day of I, KENNY W. ARMSTRONG, Clerk and Master of the Chancery Court, Shelby County Tennessee, certify this to be a true and accurate copy as filed this ____________________________________ 20 Surety KENNY W. ARMSTRONG, Clerk and Master By ____________________________ , D.C. American LegalNet, Inc. www.USCourtForms.com RETURN ON SERVICE OF SUMMONS I HEREBY CERTIFY THAT I HAVE SERVED THE WITHIN SUMMONS: day of By delivering on the , 20 a copy of the summons and a copy of the Complaint to the following defendants at M. Mark Luttrell, Sheriff By Deputy Sheriff PRIVATE PROCESS SERVER I HEREBY CERTIFY THAT I HAVE SERVED THE WITHIN SUMMONS: By delivering on the day of , 20 at summons and a copy of the Complaint to the following defendants M. a copy of the (PLEASE PRINT THE FOLLOWING) Address Private Process Server Phone Company Other manner of service: Signature I hereby certify that I have NOT served this Summons on the within named defendant(s) because is (are) not to be found in this County after diligent search and inquiry for the following reasons: ... Mark Luttrell, Sheriff This day of , 20 . By Tel. No. ______________________________ Attorney for Plaintiff Came to hand__________________________ VS. DEFENDANT PLAINTIFF SUMMONS IN CIVIL ACTIONS IN THE CHANCERY COURT OF TENNESSEE FOR THE THIRTIETH JUDICIAL DISTRICT AT MEMPHIS NO. _______________ D. ____________ Deputy Sheriff American LegalNet, Inc. www.USCourtForms.com