IN THE JUVENILE COURT OF MEMPHIS AND SHELBY COUNTY, TENNESSEE Docket Number ____________________________ SUMMONS STATE OF TENNESSEE To any lawful officer: Summon ________________________________________________________________________________ to appear before the Juvenile Court of Memphis and Shelby County, Tennessee, at 616 Adams Avenue, on the __________ day of _____________________, 20 ______, at _______ o'clock ______M., to answer the charge of the petition, a copy of which accompanies this summons, and to bring _________________________________ ___________________________________________________________________________________________. Herein fail not, and have you then and there this Writ. WITNESS, STEVE STAMSON, Clerk of said Juvenile Court, at office, in Memphis, Tennessee, this _____ day of _______________, 20 ____. STEVE STAMSON, Clerk of Court By __________________________________ D. C. OFFICER'S RETURN Came to hand ____________________, 20 ____, and executed by _____________________________________ This ______ day of _________________, 20 ______ “for disability assistance, please call,” TOM STONE (ADA COORDINATOR) Phone (901) 379-7895 Email – Stone-t@co.shelby.tn.us __________________________________________ Officer 7/15/05 JC-4 American LegalNet, Inc. www.USCourtForms.com