IN THE JUVENILE COURT OF MEMPHIS AND SHELBY COUNTY, TENNESSEE IN THE MATTER OF Docket Number _____________________________ A child(ren) under 18 years of age PETITION FOR CONTEMPT Comes your petitioner, _________________________________, and respectfully shows this Honorable Court: 1. That on the _____ day of ____________________, 20 ____, an order was entered in this Court awarding visitation to _________________________________________________________________________. 2. That the defendant, ___________________________________, has willfully failed to comply with the order of this Court regarding said visitation. PREMISES CONSIDERED, PETITIONER PRAYS: 1. That upon filing this petition an order issue requiring the defendant to show cause for his failure to comply with the orders of this Court. 2. That this Court enforce the visitation ordered herein. 3. That such further relief be granted to which petitioner may be entitled in the premises. __________________________________________ Petitioner AFFIDAVIT STATE OF TENNESSEE COUNTY OF SHELBY Before me personally appeared the petitioner in the foregoing petition, who makes oath that the statements therein are true to the best of his/her knowledge, information and belief. __________________________________________ Petitioner Sworn to and subscribed before me this ________ day of _______________________________, 20 ______ STEVE STAMSON, Clerk of Court By __________________________________ D. C. FIAT To the Clerk of the Juvenile Court of Memphis and Shelby County, Tennessee: File the foregoing petition and issue the scire facias as prayed for therein requiring the defendant to appear on the _____ day of ____________________, 20 ____, at ________ o'clock ____M. and show cause why the defendant should not be adjudged in contempt of Court and punished accordingly. This ______ day of _________________, 20 ______ __________________________________________ Juvenile Court Judge JC-21C 6/15/03 American LegalNet, Inc. www.USCourtForms.com