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COVER SHEET FOR FILING CIVIL ACTIONS

Case No.

...............................................................................

COMMONWEALTH OF VIRGINIA

(CLERK’S OFFICE USE ONLY)

Circuit Court

.................................................................................................................................................................................................................................

v./In re:

...................................................................................................................................

.........................................................................................................................

PLAINTIFF(S)

DEFENDANT(S)

...................................................................................................................................

.........................................................................................................................

I, the undersigned [ ] plaintiff [ ] defendant [ ] attorney for [ ] plaintiff [ ] defendant hereby notify the Clerk of Court that I am filing

the following civil action. (Please indicate by checking box that most closely identifies the claim being asserted or relief sought.)

GENERAL CIVIL

ADMINISTRATIVE LAW

PROBATE/WILLS AND TRUSTS

[ ] Appeal/Judicial Review of Decision of

[ ] Accounting

Subsequent Actions

[ ] Claim Impleading Third Party Defendant

(select one)

[ ] Aid and Guidance

[ ] Monetary Damages

[ ] ABC Board

[ ] Appointment (select one)

[ ] No Monetary Damages

[ ] Board of Zoning

[ ] Guardian/Conservator

[ ] Counterclaim

[ ] Compensation Board

[ ] Standby Guardian/Conservator

[ ] Monetary Damages

[ ] DMV License Suspension

[ ] Trust (select one)

[ ] No Monetary Damages

[ ] Employee Grievance Decision

[ ] Impress/Declare

[ ] Cross Claim

[ ] Employment Commission

[ ] Reformation

[ ] Interpleader

[ ] Local Government

[ ] Will (select one)

[ ] Reinstatement (other than divorce or

[ ] Marine Resources Commission

[ ] Construe

driving privileges)

[ ] School Board

[ ] Contested

[ ] Removal of Case to Federal Court

[ ] Voter Registration

Business & Contract

[ ] Other Administrative Appeal

MISCELLANEOUS

[ ] Attachment

[ ] Appointment (select one)

[ ] Confessed Judgment

DOMESTIC/FAMILY

[ ] Church Trustee

[ ] Contract Action

[ ] Adoption

[ ] Conservator of Peace

[ ] Contract Specific Performance

[ ] Adoption – Foreign

[ ] Marriage Celebrant

[ ] Detinue

[ ] Adult Protection

[ ] Bond Forfeiture Appeal

[ ] Garnishment

[ ] Annulment

[ ] Declaratory Judgment

Property

[ ] Annulment – Counterclaim/Responsive

[ ] Declare Death

[ ] Annexation

Pleading

[ ] Driving Privileges (select one)

[ ] Condemnation

[ ] Child Abuse and Neglect – Unfounded

[ ] Reinstatement pursuant to § 46.2-427

[ ] Ejectment

Complaint

[ ] Restoration – Habitual Offender or 3

[ ] Encumber/Sell Real Estate

[ ] Civil Contempt

Offense

[ ] Enforce Vendor’s Lien

[ ] Divorce (select one)

[ ] Expungement

[ ] Escheatment

[ ] Complaint – Contested*

[ ] Firearms Rights – Restoration

[ ] Establish Boundaries

[ ] Complaint – Uncontested*

[ ] Forfeiture of U.S. Currency

[ ] Landlord/Tenant

[ ] Counterclaim/Responsive Pleading

[ ] Freedom of Information

[ ] Unlawful Detainer

[ ] Reinstatement –

[ ] Injunction

[ ] Mechanics Lien

Custody/Visitation/Support/Equitable

[ ] Interdiction

[ ] Partition

Distribution

[ ] Interrogatory

[ ] Quiet Title

[ ] Separate Maintenance

[ ] Judgment Lien-Bill to Enforce

[ ] Termination of Mineral Rights

[ ] Separate Maintenance Counterclaim

[ ] Law Enforcement/Public Official Petition

Tort

[ ] Name Change

[ ] Asbestos Litigation

[ ] Referendum Elections

WRITS

[ ] Compromise Settlement

[ ] Sever Order

[ ] Certiorari

[ ] Intentional Tort

[ ] Taxes (select one)

[ ] Habeas Corpus

[ ] Medical Malpractice

[ ] Correct Erroneous State/Local

[ ] Mandamus

[ ] Motor Vehicle Tort

[ ] Delinquent

[ ] Prohibition

[ ] Product Liability

[ ] Vehicle Confiscation

[ ] Quo Warranto

[ ] Wrongful Death

[ ] Voting Rights – Restoration

[ ] Other General Tort Liability

[ ] Other (please specify)

......................................

...............................................................................

[ ] Damages in the amount of $

are claimed.

.................................................................

.......................................................................

_____________________________________________________________________

[ ]

DATE

PLAINTIFF

DEFENDANT

ATTORNEY FOR

PLAINTIFF

[ ]

DEFENDANT

................................................................................................................................................

*“Contested” divorce means any of the following matters are in

PRINT NAME

dispute: grounds of divorce, spousal support and maintenance,

................................................................................................................................................

child custody and/or visitation, child support, property distribution

ADDRESS/TELEPHONE NUMBER OF SIGNATOR

or debt allocation. An “Uncontested” divorce is filed on no fault

grounds and none of the above issues are in dispute.

................................................................................................................................................

FORM CC-1416 (MASTER) PAGE ONE 10/12

Cover Sheet For Filing Civil Actions

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