IN THE CIRCUI T CO URT OF TE NNESSEE FOR THE 30TH JUDICIAL DISTRICT AT M EMPHIS PETI TION F OR WR IT OF HA BEAS CORPUS Petitioner vs. Docket # Respondent TO THE HONORABLE JUDGES OF THE CIRCUIT COURT OF SHELBY COUNTY, TENNES SEE: COMES NOW YOUR PETITIONER Individually and as Legal Guardian of , a minor, and petitions this court for a Writ of Habeas Corpus against the Respondent and respectfully states as follows: 1. is the of , a minor born 2. On in the Court of Petitioner was awarded legal custody of the minor child. A certified copy of said Order is attached hereto and by reference made part hereof That Order has not been modified by subsequent court action. 3. Respondent is unlawfully restraining the child and depriving him/her of his/her liberty. 4. Petitioner has demanded that said child be surrendered to Petitioner by the Respondent in order that he/she might assume the lawful control, custody and care of the child to which Petitioner is entitled. Petitioner is willing and able to exercise said custody. Despite Petitioners demands, Respondent has refused to surrender the child to the custody of Petitioner. >>>> 25. It would be in the manifest best interest of the minor child for him/her to be returned to Petitioner immediately because Wherefore, because Petitioner is without remedy, except for a court having proper cognizance of the matter prays: 1. That a Writ of Habeas Corpus be granted and directed to said Respondent to appear before this Honorable Court as such time as may be designated in said Writs and to then and there show cause why the said minor child , should not be placed in the custody of your Petitioner. 2. That this court forthwith issue a warrant directed to the Sheriff of Shelby County, Tennessee authorizing and directing him to immediately take into custody the minor child and place said child in the custody of him/her to await the final Orders of the court in this cause. 3. That the Respondent pay Petitioners expenses incurred in this cause. 4. The Petitioner has such other further and or general relief to which he/she may be entitled. This is the first application for a Writ of Habeas Corpus or other extraordinary relief in this cause. Petitioner Address STATE OF TEN NESSEE CO UNTY O F SHELBY Personally appeared before me the within named wh ostated upon oath that the statements contained in the foregoing Petition for Writ of Habeas Corpus are true and co rrect to the best of his/her kno wledge, information and belief. Subscri bed and sworn before me this day of ,20 My Commission expires: Notary Public >>>> 3 FIAT To the Clerk of this court: Issue the Writ of Habeas Corpus prayed for in paragraphs one and two above and set a hearingfor said petition on the day of , 20at A.M. / P.M. Judge Date