FAIRFAX CIRCUIT COURT DOMESTIC CASE COVERSHEET Parties: Plaintiffs Defendants Name: Name: Street: Street City: State: Phone Number: ( Zip: City: ) Phone Number: ( State: Zip: ) Plaintiff proceeding without Counsel – Address and Phone number required on Complaint Plaintiffs Attorney: Name: Bar ID: Firm: Street: City: State: Zip: Phone Number: Fax Number:  Divorce – totally uncontested • Custody, support & property issues resolved or no custody, property or support issues. Intend to proceed by:  Divorce Contested • • Contested Property or Support Issues Contested Custody Issues OTHER:  Divorce  Annulment  Separate Maintenance  Ore Tenus hearing  Deposition  Unknown at this time REOPEN - DOMESTIC ISSUES:    Custody  Support  Visitation  Show Cause Other: ___________________________________________________________ Please reflect original Chancery case number: ___________________________ Requested Service:  Sheriff  Private Process Server  Notary Acceptance  Publication  No Service at this time H-42 October 2006 American LegalNet, Inc. www.FormsWorkflow.com