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LIST PERTINENT SECTION OF RENTAL AGREEMENT [OR] SECTION OF THE CODE OF VIRGINIA [OR] TYPE OF HAZARD. EXPLAIN. TO DEFENDANT: You are not required to appear; _________________
however, if you fail to appear, judgment may be entered
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against you. See the additional notice on page two about
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Plaintiff(s) – Tenant(s) therefore requests that the Court grant the following specific relief:
requesting a change of trial location. _________________
[ ] To dispute this claim, you must appear on the return _________________
................................................................................................................................................................................................ , date to try this case.
reasonable costs of Tenant, including court costs, reasonable attorney fees, and any other appropriate relief. [ ] To dispute this case, you must appear on the return _________________
I certify that all prerequisite conditions for relief, as shown on the reverse of this form, have been met. date for the judge to set another date for trial. See _________________
additional notice on page two.
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DATE TENANT _________________
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CASE DISPOSITION _________________
Judgment: [ ] Plaintiff(s) $