GENERAL SESSIONS COURT OF ____________________ COUNTY,
TENNESSEE
STATE OF TENNESSEE
vs.
_______________________________________
                                                             Defendant
State Control # __________________________
Case # _________________________________

INFORMATION ABOUT THE DEFENDANT

Name:_____________________________________
Address:____________________________________
DOB:___________________   Sex:______________
Race:___________________   Ht.:_______________
Wt.:_______  Hair:__________  Eyes:____________
Phone:__________________  DL#:______________
Place of Employment:_________________________
___________________________________________
May be Found at:_____________________________
___________________________________________
Other:____________________________________________________________________________________________________________________________

WITNESSES

Summon as witnesses on the part of the State:
___________________________________________
___________________________________________
___________________________________________
Summon as witnesses on the part of the Defendant:
___________________________________________
___________________________________________
___________________________________________

CRIMINAL SUMMONS

TO THE DEFENDANT
(  )  Based on the affidavit of complaint filed in       this case, there is probable cause to believe that you have committed the offense(s) of violation(s) of T.C.A. § ___________________________________
       _______________________________________
       
(   )  _______________________________________
       _______________________________________

_______________________________________
Judge/Clerk/Judicial Commissioner                               Date
YOU ARE HEREBY SUMMONED TO APPEAR
(   ) In the booking room at _____________________
___________________________________________
(address of booking office)
Within ten (10) calendar days from date of service of this summons.

(   ) To appear before the General Sessions Court of  _________________________ County, Tennessee in ___________________________________________ 

to answer charges on ________________________ at ___________ a.m./p.m.

NOTICE:  YOU ARE CHARGED WITH A STATE CRIMINAL OFFENSE.  THIS SUMMONS HAS BEEN ISSUED IN LIEU OF AN ARREST WARRANT.  YOUR FAILURE TO APPEAR IN COURT ON THE DAY AND TIME ASSIGNED BY THIS SUMMONS OR THE FAILURE TO APPEAR FOR BOOKING AND PROCESSING WILL RESULT IN YOUR ARREST FOR SEPARATE CRIMINAL OFFENSE PUNISHABLE AS PROVIDED IN T.C.A. §39-16-609 REGARDLESS OF THE DISPOSITION OF THE CHARGE FOR WHICH YOU WERE ORIGINALLY SUMMONED.  YOU ARE ENCOURAGED TO CONSULT WITH AN ATTORNEY ABOUT THIS SUMMONS.  THE SIGNING AND ACCEPTANCE OF THIS SUMMONS IS NOT AN ADMISSION OF GUILT OF THE CRIMINAL OFFENSE.

_______________________________________
Defendant                                                                       Date
OFFICER’S RETURN

(  )	Summons served by delivering a copy to 
	defendant today or on ______________
	________________________________
	________________________________

(  )	________________________________
	________________________________
	________________________________

Officer’s Signature:
_______________________________________
Officer’s Name (Printed):
_______________________________________
Officer’s Agency (Printed):
_______________________________________

Date: __________________________________