FORM DC-429 (MASTER, PAGE ONE OF TWO)07/19TENANT222S ASSERTION AND COMPLAINTCommonwealth of Virginia VA. CODE 247247 55-225.12; 55-248.27.............................................................................................................................................................General District Court....................................................................................................................................................................................................... STREET ADDRESS OF COURTTO ANY AUTHORIZED OFFICER:You are hereby commanded to summon the Defendant(s) to appear on ................................................................. before this court to answer.DATE AND TIME...................................................... DATE[ ] CLERK [ ] DEPUTY CLERK [ ] MAGISTRATEI, the undersigned Tenant, this day assert that Plaintiff(s) executed a lease as indicated with Defendant(s) for the rental of the dwelling unit or premises indicated.DATE LEASE EXECUTEDDATE RENTAL PERIOD COMMENCEDDATE RENTAL PERIOD ENDS AMOUNT OF RENTPERIOD AND CONDITIONS OF PAYMENTdue each The following conditions, for which relief is sought, currently exist in the dwelling unit or premises:....................................................................................................................................................................................................... ................................................................................................................................................................, and these conditions[ ]constitute material non-compliance by Defendant(s) 226Landlord(s) with the rental agreement as indicated below; [or][ ]constitute material non-compliance by Defendant(s) 226Landlord(s) with the provisions of law, as indicated below; [or][ ]will constitute a fire hazard or serious threat to the life, health, or safety of occupant, if not properly corrected, as indicated below;....................................................................................................................................................................................................... LIST PERTINENT SECTION OF RENTAL AGREEMENT [OR] SECTION OF THE CODE OF VIRGINIA [OR] TYPE OF HAZARD. EXPLAIN........................................................................................................................................................................................................ Plaintiff(s) 226 Tenant(s) therefore requests that the Court grant the following specific relief:....................................................................................................................................................................................................... .........................................................................................................................................., and any other appropriate relief.I certify that all prerequisite conditions for relief, as shown on the reverse of this form, havebeen met....................................................... DATETENANTCASE DISPOSITIONJudgment: [ ] Plaintiff(s) $ .....................................................[ ] Defendant(s) $ ........................................................$............................... costs and $ ................................. attorney fees awarded to [ ]Plaintiff(s) [ ] Defendant(s)Distribution of funds held in escrow in the court:[ ] $ .........................................Plaintiff(s) [ ] $ ................................................... Defendant(s)Other: .......................................................................................................................................................................................... ....................................................................................................................................................................................................... [ ] NON-SUIT[ ] DISMISSEDDefendant(s) present? [ ] Yes [ ] No...................................................... DATE ENTEREDJUDGE RETURN DATE CASE NO.TENANT222S ASSERTIONAND COMPLAINT............................................................................................................. PLAINTIFF(S) 226TENANT(S)............................................................................................................. ............................................................................................................. V.............................................................................................................. DEFENDANT(S) 226LANDLORD(S)............................................................................................................. ............................................................................................................. ADDRESS/LOCATION OF DWELLING UNIT OR PREMISES SUBJECT TO THIS ACTION............................................................................................................. ............................................................................................................. ............................................................................................................. TO DEFENDANT: You are not required to appear; however, if you fail to appear, judgment may be entered against you. See the additional notice on page two about requesting a change of trial location.[ ]To dispute this claim, 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. See additional notice on page two.***Bill of Particulars ...................................... ........................... ORDEREDDUEGrounds of Defense...................................... ........................... ORDEREDDUEATTORNEY FOR PLAINTIFF(S)............................................................................................................. ATTORNEY FOR DEFENDANT(S)............................................................................................................. HEARING DATE AND TIME American LegalNet, Inc. www.FormsWorkFlow.com FORM DC-429 (MASTER, PAGE TWO OF TWO)10/15PREREQUISITE CONDITIONS FOR RELIEFBEFORE THIS COURT MAY GRANT ANY RELIEF, THE FOLLOWING CONDITIONS MUST BE MET:1.The dwelling unit or premises which isthe subject of the complaint must be located within the jurisdictionof this Court, that is, within the city or county indicated in the name of this Court.2.The conditions existing in the dwelling unit or premises for which relief is sought must not have beencaused by Plaintiff(s) 226Tenant(s), nor by the family, guests or invitees of Plaintiff(s) 226Tenant(s).3.The Plaintiff(s) 226Tenant(s) must not have unreasonably refused entry to the Defendant(s) 226 Landlord(s), orthe agents of Defendant(s) 226Landlord(s) when entry was sought to make the necessary repairs.4.Prior to commencement of the action, the landlord was served a written notice by the tenant of conditionsdescribed on the front of this form, or was notified of such conditions by a violation or condemnationnotice from an appropriate state or municipal agency, and that the landlord has refused, or having areasonable opportunity to do so, has failed to remedy the same through no fault on the Tenant222s part. Suchwritten notice may be served by (a) regular mail (postage prepaid), with the sender retaining proof ofmailing (such as a U.S. Postal Service certificate of mailing) or (b) hand delivery by the sheriff or adisinterested third party, 18 years of ageor older, when delivery made in accordance with Chapter 8 ofTitle 8.01 of the Code of Virginia.5.Any and all rents due under the lease, or as modified by the Court, have been paid into the Court withinfive days of their due date.6.This action in this Court is the sole remedy now being sought by the Plaintiff(s) 226Tenant(s) for theconditions existing in the dwelling unit or premises that are the subject of this complaint.RETURNS: Each defendant was served according to law, as indicated bel