STATE OF TENNESSEE SHELBY COUNTY CHANCERY COURT PLAINTIFF (s) TO: (Name, Address & Telephone Number) DOCKET NUMBER SCIRE FACIAS TO REVIVE AND RENEW JUDGMENT DEFENDANT (s) METHOD OF SERVICE: _____ Shelby County Sheriff. _____ Sheriff of _____________________ County, Tenn. _____ Private Process Server _____ Other: _______________________________________ You are hereby commanded to appear at the time, date and place specified for the purpose of giving testimony to show cause, if any, why the judgment heretofore entered against you in the amount of $ _______________, under this Docket Number on _________________________, ________ should not be revived and renewed for an additional ten (10) years. TIME TO APPEAR: DATE TO APPEAR: PLACE TO APPEAR: Chancery Court, Part ______ 140 Adams Ave. 3rd Floor Memphis, TN 38103 This writ is being issued on behalf of: _____ Plaintiff _____ Defendant Attorney: (Name, Address & Telephone Number) Issued this _____ day of _________________, 20 _____ Donna L. Russell, Clerk & Master By: ______________________________________ Deputy Clerk & Master Attorney's Signature_________________________________________ 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 _____________________, 20 _____ I served a copy of this writ on the respondent by ___________ __________________________________________________________________________________________________ 2. _____ I certify that on _____________________, 20 _____ I failed to serve a copy of this writ on the respondent because __________________________________________________________________________________________________ __________________________________________________________________________________________________ 3. _____ Other ________________________________________________________________________________________ Sworn to and subscribed before me on this _____ day of __________________, 20 ______. __________________________________________________ Signature of Sheriff, Attorney or Attorney agent serving writ. __________________________________________________ Notary Public/Deputy Clerk My commission expires: _____________________________ __________________________________________________ Signature accepting service (Optional) Submit Two: Original & Witness Copy Form WO-7/04 American LegalNet, Inc. www.FormsWorkFlow.com