Source: http://spotidoc.com/doc/52012/form-dc-421-s-u-d
Timestamp: 2018-02-20 19:31:30
Document Index: 103428097

Matched Legal Cases: ['§ 55', '§ 8', '§ 8', '§ 55', '§ 55', '§ 55', '§ 55']

Form DC-421
b. First copy – to defendant. If more than one defendant, provide a copy for each
c. Second copy – to plaintiff.
2. All but Case Disposition prepared by plaintiff (claim, parties, and court name and address) and
clerk (Data Element Nos. 3, 4, 5, and 19). Case Disposition, orders regarding bill of particulars
and grounds of defense and order for payment of rent into court prepared by judge.
a. Form DC-413, CERTIFICATE OF MAILING POSTED SERVICE, or its equivalent – if filed by
b. Form DC-325, REQUEST FOR WITNESS SUBPOENA – if completed before this form is
c. Form DC-422, NOTICE OF HEARING TO ESTABLISH FINAL RENT AND DAMAGES.
d. Copy of five-day notice to pay or quit, or other notice of unlawful detainer, if required by
4. Preparation details
a. This form merges the application (claim) and affidavit and civil warrant onto one form so
that all but a few data elements needed for issuing the civil warrant are prepared by the
b. For Data Element No. 17, notices, such as the five-day notice to pay or quit, do not have
to be attached to this form when issued, but such notice must be presented in court at trial
either by attachment to this form or by being presented to the judge.
c. The data elements for service of process on the reverse of the SUMMONS FOR UNLAWFUL
DETAINER are to be completed for each defendant who is served.
d. In lieu of a separate certificate of mailing, the plaintiff, the plaintiff’s attorney, or the
plaintiff’s agent may complete Data Elements Nos. 10 and 11 on the back of the form if
the mailing to defendants occurs at or prior to filing of the warrant.
e. On the reverse, Data Element Nos. 12, 13 and 14 are for optional use by clerks in
tracking the issuance of post-judgment process. This data is added when such postjudgment process is prepared because the clerk’s staff has to use the warrant in preparing
and issuing post-judgment process.
This form contains a provision for the clerk to note that a Notice of Satisfaction for this
judgment has been received and is attached.
(CIVIL CLAIM FOR EVICTION)
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.
[ ] 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 $ .............................................
11 damages for ........................................................
and $ .....................
with interest ........................................
RATE(S) AND BEGINNING DATE(S)
and $ costs ................................
and $ ........................
civil recovery and $ .......................
18[ ] This summons is filed to terminate a tenancy pursuant to 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
20 day of ........................................................ , 20 ...............
Subscribed and sworn to before me this ..............
My commission expires: ..................................... ______________________________________________
NOTARY REGISTRATION NO. ....................................
[ ] CLERK [ ] DEPUTY CLERK [ ] MAGISTRATE [ ] NOTARY PUBLIC
[ ] City [ ] County of .................................................................
25 [ ] .............................................................................
[ ] JUDGMENT that Plaintiff(s) recover against
[ ] named DEFENDANT(S).
to § 8.01-128.
27 [ ] A hearing shall be held on .......................................................... to establish final rent and damages.
PLAINTIFF(S) NAME(S) (LAST, FIRST, MIDDLE)
DEFENDANT(S) NAME(S) (LAST, FIRST, MIDDLE)
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
50 date to try this case
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 possession may be issued
immediately for possession of the premises.
Bill of Particulars ordered .................................................
Grounds of Defense ordered ............................................
[ ] Rent, in the sum of $ ..........................................
and $ ................................................................
and $ .......................................
damages with interest .........................................................................
costs and $ ................................
civil recovery and $ ...........................
40 HOMESTEAD EXEMPTION WAIVED? [ ] YES [ ] NO [ ] CANNOT BE DEMANDED
41[ ] JUDGMENT FOR [ ] NAMED DEFENDANT(S) [ ] ............................................................................
] DISMISSED DEFENDANT(S) PRESENT? [ 44
42[ ] NON-SUIT [ 43
FORM DC-421 FRONT 07/14
] Immediate writ of possession authorized pursuant to Virginia Code
[ ] § 8.01-129 based upon a judgment of default for [ ] a trustee’s deed following foreclosure
29 [ ] the nonpayment of rent [ ] immediate non-remediable termination.
[ ] § 55-243(C) or § 55-248.34:1(D).
DEFENDANT(S) PRESENT? [ ] YES [ 30
[ ] Redemption tender
presented; continued to:
[ ] Defendant must pay:
into the court to be held in
and any rents coming due prior
to the next hearing date must
also be paid into the court.
DISABILITY ACCOMMODATIONS for loss of
vision, hearing, mobility, etc. Contact the court ahead of
MONEY JUDGMENT PAID OR
SATISFIED PURSUANT TO
Data Elements, front
Court name.
Court street address.
31. Date of entry of judgment for possession.
32. Signature of judge.
To be completed by court personnel:
33. Amount of judgment for rent.
Return date and time (date and time of scheduled
34. Late fee awarded.
Date of issuance of this SUMMONS.
Signature of person issuing this SUMMONS. Check the
appropriate title box below the signature line.
36. Interest rate in annual percentage rate and date from which
interest runs.
Insert street address and apartment number, if any; otherwise,
give best location and description of property (such as "State
Route 611, Box 72-A, Any place Co., Va.”--2 bedroom white
frame house).
38. Amount awarded for civil recovery.
Check and, if needed, insert reason why defendants allegedly
are unlawfully detaining the property.
Total amount of unpaid rent to date.
Rental period for which rent is unpaid.
41. Check the box on margin to indicate that judgment was for
the one or more defendants and then check the first box if
judgment for all defendants is entered. If judgment is for less
than all defendants, name the defendants for whom judgment
35. Amount of damages awarded.
37. Court costs assessed against the defendant.
39. Attorney’s fees awarded by court.
40. Check applicable box.
10. Amount of late fee, if applicable.
42. Check if a nonsuit is entered.
11. Damages, if any, caused by unlawful detainer.
43. Check if the case is dismissed as to all defendants. If
dismissal is for less than all defendants, name the defendants
for whom the case is dismissed.
12. Reasons for claiming damages.
13. Interest claimed, if applicable.
14. Amount of court costs claimed in this case.
15. Amount of civil recovery claimed.
16. Attorney’s fee (if any) claimed.
17. Check this box if plaintiff requests judgment for all amounts
due as of the date of the hearing.
18. Check this box if the case falls under the Virginia Residential
To be completed by person taking acknowledgement:
19. Signature of person filing the claim, stating notice has been
given if required. Check the appropriate title box below the
20. Date of attestation.
21. Signature of person taking the attestation. Check the
appropriate title box and, if appropriate, insert the status data
of the signer below the signature line.
22. If notary public taking the attestation, insert notary’s
23. If notary public taking the attestation, insert notary’s
24. Locality in which attestation taken. Check the appropriate
44. Check box indicating if defendant(s) were present.
45. Date of entry of judgment for rent and damages.
46. Signature of judge.
47. Court case number.
48. Names and addresses of plaintiffs.
49. Names and addresses of defendants.
To be completed by the judge or clerk:
50. Check applicable box.
51. If judge orders filing of bill of particulars, insert the
52. If judge orders filing of grounds of defense, insert the
53. Name and address of plaintiff’s attorney.
54. Name and address of defendant’s attorney.
To be completed by judge or clerk
55. Return date. Space is left for adding continuance dates.
56. Check if redemption tender presented. Enter hearing date
57. If continuance granted and judge orders defendant to pay rent
to be held in escrow by the court, insert amount of rent owed.
To be completed by the judge:
58. Date by which rent owed must be paid into the court.
25. Check the box at margin to indicate that a judgment was
given to plaintiff and check the correct box to indicate if
judgment is entered against less than all defendants or
judgment is entered against all defendants.
59. Judge’s initials.
26. Check box if possession granted to plaintiff.
60. Date NOTICE OF SATISFACTION received and attached to
61. Signature of clerk.
27. Check box if plaintiff requested time to establish final rent
and damages and insert date and time of hearing.
28. Check if immediate writ of possession is authorized.
29. Check reason immediate writ of possession is authorized.
30. Check the applicable box. If there are multiple defendants
and not all were present, list names of those present.
(1) The preferred location for an Unlawful Detainer 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
• File the written request in the clerk’s office before the trial date (use the mail 4
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
(2) If you pay the landlord or his 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
RETURNS: Each defendant was served according to law, as indicated below, unless not found.
Name . . . . . . . . . . . . . .1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address . . . . . . . . . . . . . .2
[3] 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
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
[ 6] Not found _______________________________________________
[ ] PLAINTIFF’S ATTORNEY
for _____________________________________________________
Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
[ ] Personal Service
[ ] Delivered to family member (not temporary sojourner or guest) age 16 or older at
[ ] PLAINTIFF
usual place of abode, address listed above. (Other authorized recipient not
Served on the Secretary of the Commonwealth
[ ] PLAINTIFF’S AGENT
Fi. Fa. issued on
Interrogatories issued on . . . . . . . . . . . . . . . . . .13
Garnishment issued on
FORM DC-421 REVERSE 07/13
Data Elements, reverse
1. Name of person to be summoned. If person is a corporation’s officer, designated agent,
managing employee or registered agent, show name of corporation on second line.
2. Address and telephone number of person to be summoned.
To be completed by serving officer:
3. Check this box if personal service obtained.
4. Serving officer to check the appropriate box to designate type of substitute service.
5. If served by leaving the subpoena with a family member age 16 or older, check appropriate
box and insert required information.
6. Check this box if unable to serve process.
7. Signature of serving officer.
8. Date of signature.
9. Name of sheriff if served by deputy sheriff.
10. Date that plaintiff, plaintiff’s attorney, or plaintiff’s agent mailed copy of pleading to
11. Signature of person mailing the pleading. Check the appropriate title box below the signature
For use by clerk:
12. Date(s) writ of fieri facias was issued.
13. Date(s) summons to answer interrogatories was issued.
14. Date(s) garnishment summons was issued.
A person who brings a suit before the Court.
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