CIRCUIT COURT OF TENNESSEE 140 ADAMS AVENUE, MEMPHIS, TENNESSEE 38103 FOR THE THIRTIETH JUDICIAL DISTRICT AT MEMPHIS SCIRE FACIAS ON CHARGE OF CONTEMPTTo the Sheriff of Shelby CountyWHEREAS, in a certain cause pending in the Circuit Court of Shelby County, Wherein Petitioner, and Respondent, on the dayof , 20 , an order was rendered reciting that THIS IS THEREFORE to command you to summon (One party per Scire Facias) if found to be in your County, to appear before said Circuit Court Division , at the Court House of Shelby County, in Memphis,on the day of , 20, at a.m./p.m., to show cause, if any, why the Respondent should not be adjudged in contempt for failing to comply with the order of the honorable Court.This is a charge of Civil CriminalHerein fail not, have you then and there this Writ.WITNESS, , Clerk of said Circuit Court, in Memphis, Tennessee,this day of , 20. ClerkBy: , D.C.NOTICE TO RESPONDENT: You have the right to be represented by an attorney. If you are unable to afford an attorney, and wish to have one appointed by the court, you must file a motion with the court at once, giving five (5) days notice to the Petitioner or the Petitioner's attorney(s) of the time and place your motion will be heard. You are charged with Contempt of Court, which may be of a civil and/or criminal nature. When charged with Criminal Contempt, you are not required to give evidence against yourself. You are presumed innocent until proven guilty beyond a reasonable doubt. If you are convicted of contempt, there is a possibility that you will be fined and/or imprisoned. Certified Mail Shelby County Sheriff Commissioner of Insurance ($) Secretary of State ($) Other TN County Sheriff ($) Private Process Server OtherMethod of Service:($) Attach Required Fees American LegalNet, Inc. www.FormsWorkFlow.com RETURN OF SERVICE OF SCIRE FACIAS I HEREBY CERTIFY THAT I HAVE SERVED THE WITHIN SCIRE FACIAS: By delivering on the day of , 20 at M. a copy of the Scire Facias and a copy of the Petition to the following Respondent at By: Signature of person accepting service Sheriff or other authorized person to serve process RETURN OF NON-SERVICE OF SCIRE FACIAS I HEREBY CERTIFY THAT I HAVE NOT SERVED THE WITHIN SCIRE FACIAS: To the named Respondent because is (are) not to be found in this County after diligent search and inquiry for the following reason(s): This day of , 20. By: Sheriff or other authorized person to serve process IN THE CIRCUIT COURT OF TENNESSEE FOR THE THIRTIETH JUDICIAL DISCTRICT AT MEMPHIS SCIRE FACIAS ON CHARGE OF CONTEMPT OF COURT Docket No: VSPlaintiffDefendantAttorney for Plaintiff/Pro SeTelephone Number American LegalNet, Inc. www.FormsWorkFlow.com