Form Dc 412 – Fill Out and Use This PDF

WARRANT IN DEBT (CIVIL CLAIM FOR MONEY)

Commonwealth of Virginia VA. CODE § 16.1-79

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CITY OR COUNTY

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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

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RETURN DATE AND TIME

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	DATE ISSUED	[ ] CLERK		[ ] DEPUTY CLERK [			] MAGISTRATE
CLAIM: Plaintiff(s) claim that Defendant(s) owe Plaintiff(s) a debt in the sum of
$		. net of any credits, with interest at			% from date of .			until paid,
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$ . . . . . . . . . . . . . . . . . . . costs and $ . . . . . . . . . . . . . . . . . . attorney’s fees with the basis of this claim being

[] Open Account [] Contract [] Note [] Other (EXPLAIN)

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HOMESTEAD EXEMPTION WAIVED? [] YES [] NO [] cannot be demanded

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	DATE	[ ] PLAINTIFF [ ] PLAINTIFF’S ATTORNEY [ ] PLAINTIFF’S EMPLOYEE/AGENT

CASE DISPOSITION

JUDGMENT against [ ] named Defendant(s) [ ] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

for $

net of any credits, with interest at

% from date

of . . . . . . . . . . . . . . . . . . . . . . . . . . until paid, $. . . . . . . . . . . . . . . costs and $. . . . . . . . . . . . . . . . . . . . .attorney’s fees

HOMESTEAD EXEMPTION WAIVED? [ ] YES [ ] NO [ ] CANNOT BE DEMANDED

[ ] JUDGMENT FOR [ ] NAMED DEFENDANT(S) [ ] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

[ ] NON-SUIT [ ] DISMISSED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Defendant(s) Present? [ ] YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

[] NO

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DATE	JUDGE

CASE NO.

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PLAINTIFF(S) (LAST NAME, FIRST NAME, MIDDLE INITIAL)

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V.

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DEFENDANT(S) (LAST NAME, FIRST NAME, MIDDLE INITIAL)

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WARRANT IN DEBT

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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.

Bill of Particulars	. . . . . . . . . . . . . . .
ORDERED	DUE
Grounds of Defense	. . . . . . . . . . . . . .
ORDERED	DUE

ATTORNEY FOR PLAINTIFF(S)

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ATTORNEY FOR DEFENDANT(S)

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HEARING DATE

AND TIME

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JUDGMENT PAID OR

SATISFIED

PURSUANT TO

ATTACHED NOTICE

OF

SATISFACTION.

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DATE

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CLERK

DISABILITY

ACCOMMODATIONS

for loss of hearing,

vision, mobility, etc., contact the court ahead of time.

NAME.........................................................

.................................................................

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.

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[] 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

[ ] NOT FOUND

____________________________

SERVING OFFICER

...................... for___________________________

DATE

NAME ..............................................................

......................................................................

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.

_____________________________________________

_____________________________________________

[] 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

[] NOT FOUND

____________________________

SERVING OFFICER

..................... for _____________________________

DATE

NAME ..............................................................

......................................................................

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.

_______________________________________________

_______________________________________________

[] 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

[] NOT FOUND

________________________

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:

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) the phrase "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.

3.If you mail this request to the court, you will be notified of the judge's decision.

I certify that I mailed a copy of this document to the defendants named therein at the address shown therein on

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DATE	[	] Plaintiff
	[	] Plaintiff's Atty.
	[	] Plaintiff’s Agent

Fi. Fa. issued on ............................................................................

Interrogatories issued on: ..............................................................

Garnishment issued on ..................................................................

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