AFFIDAVIT for Summons in Interpleader I, the undersigned applicant, state under oath the following: 1. . VA. CODE ANN. §§ 16.1-119-120 RETURN DATE CASE NO. ............................................................................................................................................................................................................... General District Court On .......................................................................... DATE in connection with this case AFFIDAVIT for Summons in Interpleader [ ] an execution on the judgment entered in this case was levied on certain property, namely: [ ] a warrant of distress was levied on certain property involved in this case, namely: [ ] a lien was acquired on money or other personal estate not capable of being levied upon, namely: ........................................................................................................ PLAINTIFF ........................................................................................................ V. ............................................................................................................................................................................................................................................................. DESCRIPTION OF PROPERTY 2. [ ] To the best of my belief, the property in question is not of greater value than the maximum jurisdictional limits of the court. [ ] This claim involves the disposition of an earnest money deposit pursuant to a real estate purchase contract. ........................................................................................................ DEFENDANT ........................................................................................................ ........................................................................................................ 3. The above-named property is about to be sold, or finally disposed of in order to satisfy the [ ] judgment [ ] distress warrant [ ] lien on ....................................................................... DATE OF SALE OR HEARING at .............................................................................................................................................................................; LOCATION OF SALE OR HEARING 4. . I claim the following interest in the property: .................................................................................................. NAME OF APPLICANT .................................................................................................. ADDRESS ............................................................................................................................................................................................................................................................. and request the Court to issue forthwith a Summons in Interpleader to be served on all parties to the original action named at right to have them show cause why the above described property should not be discharged from the sale, and that such summons be made returnable according to law. .......................................................................................... DATE .................................................................................................. ______________________________________________________________ APPLICANT'S SIGNATURE The AFFIDAVIT above was subscribed and sworn to before me this day: .......................................................................................... DATE ______________________________________________________________ CLERK FOR NOTARY PUBLIC'S USE ONLY: State of ................................................................................................ [ ] City [ ] County of ........................................................................................... Acknowledged, subscribed and sworn to before me this ................................. day of ............................................................................, 20 .................. by .................................................................................................................................. ............................................................................................................. NOTARY REGISTRATION NUMBER _____________________________________________________ NOTARY PUBLIC (My commission expires: ..................................................................... ) American LegalNet, Inc. www.FormsWorkFlow.com FORM DC-432 MASTER 11/10