Form Dc 421 – Fill Out and Use This PDF

SUMMONS FOR UNLAWFUL DETAINER (CIVIL CLAIM FOR EVICTION)

Commonwealth of VirginiaVA. CODE § 8.01-126

...................................................................................................................................... General District Court

CITY OR COUNTY

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

STREET ADDRESS OF COURT

TO 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 [ ] MAGISTRATE

CLAIM AND AFFIDAVIT: That Defendant(s) unlawfully detains and withholds from Plaintiff(s):

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

ADDRESS/DESCRIPTION OF DETAINED PROPERTY

and 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
	RENT		PERIOD
and $		damages for	with interest
			RATE(S) AND BEGINNING DATE(S)
and $		costs and $	civil recovery and $	attorney’s 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 by the Virginia Residential Landlord and

Tenant Act, § 55-248.2 et seq. of the Code of Virginia.

All required notices have been given. ______________________________________________________

		[ ] PLAINTIFF(S) [ ] PLAINTIFF’S ATTORNEY [ ] PLAINTIFF’S AGENT
Subscribed 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 § 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 § 8.01-129 upon request of Plaintiff. [ ] granted pursuant to Va. Code § 55-243(C) or § 55-248.34:1(C).

DEFENDANT(S) PRESENT? [ ] YES [ ] NO

............................................................... __________________________________________________

	DATE		JUDGE
[	] Rent, in the sum of $	..........................................	and $	late fee
and $		damages with interest		and
			RATE(S) AND BEGINNING DATE(S)
$	............................ costs and $		civil recovery and $	attorney’s 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
FORM DC-421 FRONT 07/19

CASE NO.

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

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

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

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

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

TELEPHONE NUMBER

v.

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

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

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

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

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

TELEPHONE NUMBER

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 and your right to prevent this unlawful detainer action through payment of amounts owed.

[] To dispute this case, you must appear on the return date to try this case

[] To dispute this case, you must appear 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 eviction may be issued immediately for possession of the premises.

Bill of Particulars ordered ...................................................

DUE DATE

Grounds of Defense ordered ..............................................

DUE DATE

ATTORNEY FOR PLAINTIFF(S)

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

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

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

TELEPHONE NUMBER

ATTORNEY FOR DEFENDANT(S)

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

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

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

TELEPHONE NUMBER

DISABILITY 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 OWED

into the court to be held in escrow by

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

DATE

and any rents coming due prior to the next hearing date must also be paid into the court.

____________________________

JUDGE’S INITIALS

MONEY JUDGMENT PAID OR SATISFIED PURSUANT TO ATTACHED NOTICE OF SATISFACTION

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

DATE

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

CLERK

To the Defendant(s):

(1)The preferred location for an Unlawful Detainer (Civil Claim for Eviction) action is the city or county where the property is located. If the plaintiff has filed this case in a city or county other than where the property you rent is located, you may object to the location. The court may transfer the case to the preferred location, if the court agrees with you. The court may award costs and attorney’s fees to you if the court agrees with your objection. To object to the location of the suit, you must do the following:

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 left column under the words “TO THE DEFENDANT(S),” (c) Plaintiff(s)’ name(s) and your 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.

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 the plaintiff.

If you mail your written request to the court, the clerk will notify you of the judge’s decision.

(2)If you pay the landlord or the landlord’s attorney or pay into court all (i) rent due and owing as of the court date as contracted for in the rental agreement, (ii) other charges and fees as contracted for in the rental agreement, (iii) late charges contracted for in the rental agreement, (iv) reasonable attorney fees as contracted for in the rental agreement or as provided by law, and (v) costs of the proceeding as provided by law, this unlawful detainer action will be dismissed pursuant to Virginia Code § 55-243 or 55-248.34:1. You may exercise this right only once every 12 months that you continue to live in the same place, regardless of the term of the rental agreement or any renewal term.

(3)You may tell your landlord that you want another person to receive a copy of this summons, and the landlord shall send a copy to that person. However, the person you identify will not, by receiving a copy of the summons, become a party to the case or be able to challenge the landlord’s actions on your behalf. Virginia Code § 55-248.9:1

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

.............................	_______________________________________________________
DATE	[ ] PLAINTIFF [ ] PLAINTIFF’S ATTORNEY [ ] PLAINTIFF’S AGENT

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

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

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

RETURNS: Each defendant was served according to law, as indicated below, unless not found.

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 the 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 the Secretary of the Commonwealth

	[ ] Not found	_______________________________________________
		SERVING OFFICER
		for _____________________________________________________
	.......................
	DATE