IN THE CHANCERY COURT FOR SHELBY COUNTY, TENNESSEE THIRTIETH JUDICIAL DISTRICT AT MEMPHIS ________________________________________ Plaintiff(s) Vs. Docket No. ____________________ ________________________________________ Defendant(s) TO THE SHERIFF OF SHELBY COUNTY: Whereas, _________________________________, plaintiff, has filed a Complaint in the Chancery Court of Shelby County, against __________________________________, defendant, and the said defendant designs quickly to leave the State, as by oath appears and said plaintiff praying for a writ of Ne Exeat Republica to stay the departure of the said defendant __________________________________. Now, therefore, by Fiat of _______________________________, Chancellor, Part ____, of the Chancery Court of Shelby County to me directed, by you are hereby commanded without delay to cause said _____________________________________, defendant, to give a good and sufficient bail bond in the penalty of $ _____________, conditioned not to leave the State of Tennessee, without permission of said Court; and if said _________________________ fail, or refuse, to give such bond, then you will commit him/her to the jail/Correctional Center of your County, there safely to be kept until he/she give such bond, or until further order from the Court. You will report your action on this writ as soon as executed and return this writ of said bond, if made. Witness my hand at office this the _____ day of ____________, 20 _____. DONNA L. RUSSELL, CLERK & MASTER by _________________________________ D.C.&M. Form W0-05/04 American LegalNet, Inc. www.FormsWorkFlow.com Return on Service of Writ I hereby certify that: ____ I have served the within Writ by delivering a copy of the Writ and a copy of the Complaint on the Defendant and ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____ Bail Posted in the amount of $ ______ and released on _______________________ Docket No. __________________________ CHANCERY COURT Shelby County, Tenn. ______________________________ Plaintiff Vs. Defendant {WRIT NE EXEAT ______________________________ Came to hand ________________________ ____ I failed to serve a copy of this Writ and Complaint on the Defendant because: ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ This ____ day of ______________, 20____ At _____________. M. Bill Oldham, Sheriff ____________________________________ Attorney ____________________________________ Phone No. American LegalNet, Inc. www.FormsWorkFlow.com By __________________________ Deputy Sheriff