V I R G I N I A: IN THE CIRCUIT COURT OF FAIRFAX COUNTY _____________________ PLAINTIFF CASE NUMBER______________ VS ________________________ JUDGMENT NUMBER:______________ DEFENDANT LEVY REQUEST The Clerk of the court will please forward to the Sheriff of execution against an who is located at ________________________________________________________________________________. The Sheriff of will levy on the following: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Judgment against said Defendant was obtained on ______________________________ in the principal amount of ________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________ (Attorney/Pro Se Signature) _________________________________ (Print Legibly Attorney/Pro Se Name) (Address) _________________________________ _________________________________ (Phone Number) CCR-150 LEVY REQUEST FORM (Revised March 15, 2002) American LegalNet, Inc. www.USCourtForms.com