State of Tennessee, County of Shelby CIVIL WARRANT NO. To Any Lawful Officer to Execute and Return: Summon to appear before the Court of General Sessions of Shelby County, Tennessee, Room 106 Shelby County Courthouse, 140 Adams Ave., Memphis, Tennessee Defendant Defendant Defendant Address Address Address on DAY DATE 20 TIME A.M. / P.M. to answer in a civil action brought by the Plaintiff (s) for Issued this under day of Dollars 20 Atty. For Plft. Address Phone EDWARD L. STANTON, JR., Clerk Pro Tempore of General Sessions Court Code No. B.P.R. No. By Deputy Clerk JUDGMENT Judgment for and Cost of suit and litigation taxes, for which Execution may issue. This day 20 Judge of Division SERVICE Came to hand same day issued and executed as commanded on This day of 20 Came to hand same day issued and executed as commanded on This Sheriff/Process Server ***SEE OTHER SIDE FOR ADDITIONAL SERVICE**** day of 20 Sheriff/Process Server American LegalNet, Inc. www.FormsWorkFlow.com ****AND NOTICE TO DEFENDANT(S)**** Came to hand same day issued and executed as commanded on This day of Came to hand same day issued and executed as commanded on 20 Sheriff/Process Server This day of 20 Sheriff/Process Server NOTICE TO THE DEFENDANT (S): Pursuant to Tennessee code annotated 26-2-114, you are hereby given the following notice: Tennessee law provides a ten thousand dollar ($10,000.00) 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 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. AFFIDAVIT To the best of my information and belief, after investigation of Defendant's employment, I hereby make affidavit that the Defendant is / is not a member of a military service. Attorney for Plaintiff or Plaintiff Notary Public My Commission Expires: For Assistance in accessing the Courthouse: (901) 379-7890 American LegalNet, Inc. www.FormsWorkFlow.com