(CIRCUIT/CHANCERY) COURT OF TENNESSEE 140 ADAMS AVENUE, MEMPHIS, TENNESSEE 38103 FOR THE THIRTIETH JUDICIAL DISTRICT AT MEMPHIS SUMMONS IN CIVIL ACTION Lawsuit Docket No. Divorce Ad Damnum $ VS Plaintiff(s) Defendant(s) TO: (Name and Address of Defendant (One defendant per summons)) Method of Service: Certified Mail Shelby County Sheriff Commissioner of Insurance ($) Secretary of State ($) Other TN County Sheriff ($) Private Process Server Other ($) Attach Required Fees 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 telephone 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. , Clerk / DONNA RUSSELL, Clerk and Master TESTED AND ISSUED By , D.C. TO THE DEFENDANT: NOTICE; Pursuant to Chapter 919 of the Public Acts of 1980, you are hereby given the following notice: Tennessee law provides a ten thousand dollar ($10,000) 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 wish 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. FOR AMERICANS WITH DISABILITIES ACT (ADA) ASSISTANCE ONLY, CALL (901) 222-2341 I, / DONNA RUSSELL , Clerk of the Court, Shelby County, Tennessee, certify this to be a true and accurate copy as filed this 20 , Clerk / DONNA RUSSELL, Clerk and Master By: , D.C. American LegalNet, Inc. www.FormsWorkFlow.com RETURN OF SERVICE OF SUMMONS I HEREBY CERTIFY THAT I HAVE SERVED THE WITHIN SUMMONS: By delivering on the day of , 20 at M. a copy of the summons and a copy of the Complaint to the following Defendant at By: Signature of person accepting service Sheriff or other authorized person to serve process RETURN OF NON-SERVICE OF SUMMONS I HEREBY CERTIFY THAT I HAVE NOT SERVED THE WITHIN SUMMONS: To the named Defendant 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 American LegalNet, Inc. www.FormsWorkFlow.com