FORM DC-421 FRONT07/19 CASE NO........................................................................................................PLAINTIFF(S) NAME(S) (LAST, FIRST, MIDDLE).....................................................................................................................................................................................................................................................................................................................TELEPHONE NUMBERv........................................................................................................DEFENDANT(S) NAME(S) (LAST, FIRST, MIDDLE).....................................................................................................................................................................................................................................................................................................................TELEPHONE NUMBERTO DEFENDANT:You are not required to appear; however, if you fail to appear, judgment may be entered against you. See the additional notice on the reverse about requesting a change of trial location and your right to prevent this unlawful detainer action through payment of amounts owed. [ ] To dispute this case, you mustappear on the return date to try this case[ ] To dispute this case, you mustappear on the return date for the judge to set another date for trial.If you fail to appear and a default judgment is entered against you, a writ of evictionmay be issued immediately for possession of the premises.Bill of Particulars ordered ...................................................DUE DATEGrounds of Defense ordered ..............................................DUE DATEATTORNEY FOR PLAINTIFF(S).....................................................................................................................................................................................................................................................................................................................TELEPHONE NUMBERATTORNEY FOR DEFENDANT(S).....................................................................................................................................................................................................................................................................................................................TELEPHONE NUMBERDISABILITY ACCOMMODATIONS for loss of vision, hearing, mobility, etc. Contact the court ahead of time. HEARING DATE AND TIME [ ]Redemption tender presented; continued to:............................................................ HEARING DATE AND TIME[ ] Defendant must pay:$............................................. RENT OWEDinto the court to be held in escrow by.................................................DATEand any rents coming due prior to the next hearing date must also be paid into the court. JUDGE222S INITIALSSUMMONS FOR UNLAWFUL DETAINER(CIVIL CLAIM FOR EVICTION)Commonwealth of Virginia VA. CODE 247 8.01-126...................................................................................................................................... General District CourtCITY OR COUNTY..........................................................................................................................................................................STREET ADDRESS OF COURTTO ANY AUTHORIZED OFFICER: Summon the Defendant(s) as provided below:TO THE DEFENDANT(S): You are commanded to appear before this Court on................................................................................................................................ to answer this civil claim.RETURN DATE AND TIME............................................................DATE ISSUED[ ] CLERK [ ] DEPUTY CLERK [ ] MAGISTRATECLAIM AND AFFIDAVIT:That Defendant(s) unlawfully detains and withholds from Plaintiff(s): .............................................................................................................................................................................ADDRESS/DESCRIPTION OF DETAINED PROPERTYand that the Defendant should be removed from possession based on the following:[ ] unpaid rent [ ]............................................................................................................................................... and further that rent is due and owing and damages have been incurred as follows: $................................. rent due for................................................ and $ ............................................. late fee RENTPERIODand $ ..................... damages for........................................................ withinterest ........................................ RATE(S) AND BEGINNING DATE(S)and $ ......................................... costs and $ ............... civil recovery and $ ....................... attorney222s fees.[ ]Plaintiff requests judgment for all amounts due as of the date of the hearing.[ ]This summons is filed to terminate a tenancy not governed bythe Virginia Residential Landlord and Tenant Act, 247 55-248.2 et seq. of the Code of Virginia.All required notices have been given. [ ] PLAINTIFF(S) [ ]PLAINTIFF222S ATTORNEY [ ] PLAINTIFF222S AGENTSubscribed and sworn to before me this .............. day of ........................................................, 20 ...............My commission expires: ..................................... NOTARY REGISTRATION NO. ....................................[ ] CLERK [ ] DEPUTY CLERK [ ] MAGISTRATE [ ] NOTARY PUBLIC[ ] City [ ] County of ................................................................. CASE DISPOSITION [ ] ............................................................................. [ ] JUDGMENT that Plaintiff(s) recover against[ ] named DEFENDANT(S).[ ] possession of the premises described above pursuant to 247 8.01-128.[ ] A hearing shall be held on.......................................................... to establish final rent and damages.DATE AND TIME[ ] Immediate writ of eviction[ ]ordered pursuant to Va. Code 247 8.01-129 upon request of Plaintiff. [ ] granted pursuant to Va. Code 247 55-243(C) or 247 55-248.34:1(C). DEFENDANT(S) PRESENT? [ ] YES [ ] NO ............................................................... DATEJUDGE[ ] Rent, in the sum of $ .......................................... and $................................................................ late fee and $ .......................................damages with interest ......................................................................... and RATE(S) AND BEGINNING DATE(S)$ ............................ costs and $ ................................ civil recovery and $........................... attorney222s fees[ ] and $ ........................... costs for Servicemembers Civil Relief Act counsel fees.HOMESTEAD EXEMPTION WAIVED? [ ] YES [ ] NO [ ] CANNOT BE DEMANDED[ ] JUDGMENT FOR [ ] NAMED DEFENDANT(S) [ ] ............................................................................$ .............................................. costs and $ ........................................... attorney fees awarded to Defendant(s) ..........................................................................................................................[ ] NON-SUIT [ ] DISMISSED DEFENDANT(S) PRESENT? [ ] YES [ ] NO...................................................................... DATE JUDGE MONEY JUDGMENT PAID OR SATISFIED PURSUANT TO ATTACHED NOTICE OF SATISFACTION ..................................................... DATE..................................................... CLERK American LegalNet, Inc. www.FormsWorkFlow.com FORM DC-421 REVERSE07/19To the Defendant(s):(1)The preferred location for an Unlawful Detainer (Civil Claim for Eviction) action isthe city or county where the property islocated. If the plaintiff has filed this case ina city or county other than where the property you rent is located, you may object tothe location. The court may transfer the case to the preferred location, if the courtagrees with you