FORM CC-1416 (MASTER) PAGE ONE 07/16 COVER SHEET FOR FILING CIVIL ACTIONS Case No. ............................................................................. COMMONWEALTH OF VIRGINIA (CLERK222S 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 Subsequent Actions [ ] Claim Impleading Third Party Defendant [ ] Monetary Damages [ ] No Monetary Damages [ ] Counterclaim [ ] Monetary Damages [ ] No Monetary Damages [ ] Cross Claim [ ] Interpleader [ ] Reinstatement (other than divorce or driving privileges) [ ] Removal of Case to Federal Court Business & Contract [ ] Attachment [ ] Confessed Judgment [ ] Contract Action [ ] Contract Specific Performance [ ] Detinue [ ] Garnishment Property [ ] Annexation [ ] Condemnation [ ] Ejectment [ ] Encumber/Sell Real Estate [ ] Enforce Vendor222s Lien [ ] Escheatment [ ] Establish Boundaries [ ] Landlord/Tenant [ ] Unlawful Detainer [ ] Mechanics Lien [ ] Partition [ ] Quiet Title [ ] Termination of Mineral Rights Tort [ ] Asbestos Litigation [ ] Compromise Settlement [ ] Intentional Tort [ ] Medical Malpractice [ ] Motor Vehicle Tort [ ] Product Liability [ ] Wrongful Death [ ] Other General Tort Liability ADMINISTRATIVE LAW [ ] Appeal/Judicial Review of Decision of (select one) [ ] ABC Board [ ] Board of Zoning [ ] Compensation Board [ ] DMV License Suspension [ ] Employee Grievance Decision [ ] Employment Commission [ ] Local Government [ ] Marine Resources Commission [ ] School Board [ ] Voter Registration [ ] Other Administrative Appeal DOMESTIC/FAMILY [ ] Adoption [ ] Adoption 226 Foreign [ ] Adult Protection [ ] Annulment [ ] Annulment 226 Counterclaim/Responsive Pleading [ ] Child Abuse and Neglect 226 Unfounded Complaint [ ] Civil Contempt [ ] Divorce (select one) [ ] Complaint 226 Contested* [ ] Complaint 226 Uncontested* [ ] Counterclaim/Responsive Pleading [ ] Reinstatement 226 Custody/Visitation/Support/Equitable Distribution [ ] Separate Maintenance [ ] Separate Maintenance Counterclaim WRITS [ ] Certiorari [ ] Habeas Corpus [ ] Mandamus [ ] Prohibition [ ] Quo Warranto PROBATE/WILLS AND TRUSTS [ ] Accounting [ ] Aid and Guidance [ ] Appointment (select one) [ ] Guardian/Conservator [ ] Standby Guardian/Conservator [ ] Custodian/Successor Custodian (UTMA) [ ] Trust (select one) [ ] Impress/Declare/Create [ ] Reformation [ ] Will (select one) [ ] Construe [ ] Contested MISCELLANEOUS [ ] Amend Death Certificate [ ] Appointment (select one) [ ] Church Trustee [ ] Conservator of Peace [ ] Marriage Celebrant [ ] Approval of Transfer of Structured Settlement [ ] Bond Forfeiture Appeal [ ] Declaratory Judgment [ ] Declare Death [ ] Driving Privileges (select one) [ ] Reinstatement pursuant to 247 46.2-427 [ ] Restoration 226 Habitual Offender or 3rd Offense [ ] Expungement [ ] Firearms Rights 226 Restoration [ ] Forfeiture of Property or Money [ ] Freedom of Information [ ] Injunction [ ] Interdiction [ ] Interrogatory [ ] Judgment Lien-Bill to Enforce [ ] Law Enforcement/Public Official Petition [ ] Name Change [ ] Referendum Elections [ ] Sever Order [ ] Taxes (select one) [ ] Correct Erroneous State/Local [ ] Delinquent [ ] Vehicle Confiscation [ ] Voting Rights 226 Restoration [ ] Other (please specify) ............................................................................ ...................................................................... DATE [ ] PLAINTIFF [ ] DEFENDANT [ ] ATTORNEY FOR [ ] PLAINTIFF [ ] DEFENDANT ............................................................................................................................................ PRINT NAME ............................................................................................................................................ ADDRESS/TELEPHONE NUMBER OF SIGNATOR ............................................................................................................................................ ............................................................................................................................................ EMAIL ADDRESS OF SIGNATOR (OPTIONAL) * 223Contested 224 divorce means any of the following matters are in dispute: grounds of divorce, spousal support and maintenance, child custody and/or visitation, child support, property distribution or debt allocation. An 223Uncontested224 divorce is filed on no fault grounds and none of the above issues are in dispute. [ ] Damages in the amount of $ ............................................................... are claimed. American LegalNet, Inc. www.FormsWorkFlow.com FORM CC-1416 (MASTER) PAGE TWO 10/17 Civil Action Type Codes (Clerk222s Office Use Only) Accounting .......................................................................... ACCT Adoption ............................................................................... ADOP Adoption 226 Foreign .......................................................... FORA Adult Protection .................................................................. PROT Aid and Guidance .................................................................. AID Amend Death Certificate ................................................... ADC Annexation ........................................................................ ANEX Annulment ........................................................................... ANUL Annulment 226 Counterclaim/Responsive Pleading .. ACRP Appeal/Judicial Review ABC Board .................................................................... ABC Board of Zoning ........................................................ ZONE Compensation Board .............................................. ACOM DMV License Suspension ............................................. JR Employment Commission ........................................ EMP Employment Grievance Decision .......................... GRV Local Government ................................................... GOVT Marine Resources ....................................................... MAR School Board ..................................................................... JR Voter Registration .................................................... AVOT Other Administrative Appeal ............................... AAPL Appointment Conservator of Peace .................................................. COP Church Trustee .......................................................... AOCT Custodian/Successor Custodian (UTMA) ...... UTMA Guardian/Conservator .............................................. APPT Marriage Celebrant ................................................. ROMC Standby Guardian/Conservator ........................... STND Approval of Transfer of Structured Settlement .............. SS Asbestos Litigation .................................................................. AL Attachment .............................................................................. ATT Bond Forfeiture Appeal ...................................................... BFA Child Abuse and Neglect 226 Unfounded Complaint .. CAN Civil Contempt ................................................................... CCON Claim Impleading Third Pa