City of Alexandria Circuit Court Civil Case Cover Sheet PLAINTIFF LAST NAME FIRST NAME DEFENDANT LAST NAME FIRST NAME (SHOW ONLY FIRST PLAINTIFF AND FIRST DEFENDANT) PLAINTIFF ATTORNEY: _________________________________________ Firm: ____________________________________________________ ****ADDRESS and PHONE NUMBERS REQUIRED FOR ALL FILERS**** Address: ____________________________________________________ ____________________________________________________ ____________________________________________________ _______________________ Phone Number ___________________________ Attorney Bar Number [ ] Serve by Sheriff ( Sheriff fee included with filing fee) [ ] Private Service. When ready, please call ______________________________ [ ] Clerk to prepare Acceptance Before Notary When ready, please call__________________ [ ] Acceptance and/or Waiver of Process Filed (attorney prepares) [ ] Acceptance and/or Waiver of Process to be Filed later (attorney prepares) [ ] Statutory Agent. Separate fee, necessary affidavits and extra copies of process included. [ ] Accept and Waive Before Clerk ($10.00 Fee) [ ] Order of Publication. Separate fee for Newspaper included. [ ] Do Not Issue Summons At This Time [ ] Other ____________________________________________________________ __________________________________________________________________ __________________________________________________________________________________ CLERK’S USE: P R O C E S S Case Number: ________________________ Is this a divorce or annulment [ ] yes [ ] no Are they seeking monetary damages in the case? [ ] Yes [ ] No Amount of damages sought: $____________________________ Amount Filing Fee Paid: $____________________________ Number of Sheriff Services Paid: _________ [ ] Name change requested - Fee paid _________ [ ] Fee for Newspaper for Order of Publication [ ] Check(s) for Statutory Agents [ ] Order & Affidavit to Waive Filing Fees [ ] VS-4 Form included [ ] VS-21 Form included [ ] Notice or Praecipe to Schedule- Date To Schedule: _____________________ American LegalNet, Inc. www.USCourtForms.com