WARRANT IN DEBT—INTERPLEADER Commonwealth of Virginia RETURN DATE CASE NO. Va. Code § 16.1-79 Connecting Case No. ........................................................................................................... General District Court CITY OR COUNTY PLAINTIFF(S) ............................................................................................................................................... STREET ADDRESS OF COURT TO ANY AUTHORIZED OFFICER: You are hereby commanded to summon the Defendant(s). TO THE DEFENDANT(S): You are summoned to appear before this Court at the above address on V. DEFENDANT(S) ............................................................................................... to answer the Plaintiff(s)’ civil claim and RETURN DATE AND TIME interplead your claims (see below) _______________________________________________ [ ] CLERK [ ] DEPUTY CLERK [ ] MAGISTRATE ................................... DATE ISSUED CLAIMS: Plaintiff(s) claim that Defendant(s) have or may have claims in the following personal property or money held by or on behalf of Plaintiff(s). WARRANT IN DEBT – INTERPLEADER .................................................................................................................................................. * * * DESCRIPTION Plaintiff(s) further claim that: [ ] no other case is connected with this warrant in debt [ ] this action is connected with . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLAINTIFF(S) DEFENDANT(S) ............................................................................................................................................... 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 the reverse about requesting a change of trial location. [ ] To dispute this claim, you must appear on the return date to try this case. [ ] To dispute this claim, you must appear on the return date for the judge to set another date for trial. COURT NAME AND CASE NUMBER Plaintiff(s) request that this court determine the rights of the parties to the personal property or money described above. * * * Bill of Particulars . . . . . . . . . . . . . . . . . . . . . . ORDERED ____________________________________________________________________ [ ] PLAINTIFF [ ] PLAINTIFF’S EMPLOYEE /AGENT [ ] PLAINTIFF’S ATTORNEY ....................... DATE Grounds of Defense . . . . . . . . . . . . . . . . . . . . . . ORDERED ............... DUE .............. DUE ATTORNEY FOR PLAINTIFF(S) CASE DISPOSITION Use Form DC-480 ................................................................................ DISABILITY ACCOMMODATIONS for loss of hearing, vision, mobility, etc., contact the court ahead of time. ATTORNEY FOR DEFENDANT(S) ................................................................................ FORM DC-428 (MASTER, PAGE ONE OF TWO) 7/04 American LegalNet, Inc. www.FormsWorkflow.com RETURNS: Each defendant was served according to law, as indicated below, unless not found. NAME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NAME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NAME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................................................................. ...................................................................... ...................................................................... ADDRESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ADDRESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ADDRESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................................................................. ...................................................................... ...................................................................... [ ] PERSONAL SERVICE Tel. No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Being unable to make personal service, a copy was delivered in the following manner: [ ] Delivered to family member (not temporary sojourner or guest) age 16 or older at usual place of abode of party named above after giving information of its purport. List name, age of recipient, and relation of recipient to party named above. [ ] PERSONAL SERVICE Tel. No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Being unable to make personal service, a copy was delivered in the following manner: [ ] Delivered to family member (not temporary sojourner or guest) age 16 or older at usual place of abode of party named above after giving information of its purport. List name, age of recipient, and relation of recipient to party named above. [ ] PERSONAL SERVICE Tel. No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Being unable to make personal service, a copy was delivered in the following manner: [ ] Delivered to family member (not temporary sojourner or guest) age 16 or older at usual place of abode of party named above after giving information of its purport. List name, age of recipient, and relation of recipient to party named above. _____________________________________________ _____________________________________________ _______________________________________________ _____________________________________________ [ ] Posted on front door or such other door as appears to be the main entrance of usual place of abode, address listed above. (Other authorized recipient not found.) _____________________________________________ [ ] Posted on front door or such other door as appears to be the main entrance of usual place of abode, address listed above. (Other authorized recipient not found.) _______________________________________________ [ ] Posted on front door or such other door as appears to be the main entrance of usual place of abode, address listed above. (Other authorized recipient not found.) [ ] Served on Secretary of the Commonwealth [ ] Served on Secretary of the Commonwealth [ ] Served on Secretary of the Commonwealth [ ] Not found [ ] Not found [ ] Not found ____________________________ SERVING OFFICER ...................... for ___________________________ DATE ____________________________ SERVING OFFICER ..................... for _____________________________ DATE OBJECTION TO VENUE: To the Defendant(s): If you believe that Plaintiff(s) should have filed this suit in a different city or county, you may file a written request to have the case moved for trial to the general district court of that city or county. To do so, you must do the following: ________________________ SERVING OFFICER ...................... for ___________________________ DATE I certify that I mailed a copy of this document to the defendants named therein at the address shown therein on .................................... ______________________________ DATE [ ] Plaintiff [ ] Plaintiff's Atty. [ ] Plaintiff’s Employee/Agent 1. Prepare a written request which contains (a) this court's name, (b) the case number and the "return date" as shown on the other side of this form in the right corner, (c) Plaintiff(s)' name(s) and Defendant(s)' name(s), (d) "I move to object to venue of this case in this court because" and state the reasons for your objection and also state in which city or county the case should be tried, and (e) your signature and mailing address. 2. File the written request in the clerk's office before the trial date (use the mail at your own risk) or give it to the judge when your case is called on the return date. Also send or deliver a copy to plaintiff. Fi. Fa. issued on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. If you mail this request to the court, you will be notified of the judge's decision. Garnishment issued on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Interrogatories issued on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................................................................... FORM DC-428 (MASTER, PAGE TWO OF TWO) 10/07 American LegalNet, Inc. www.FormsWorkflow.com