Virginia Name Change Civil Cover Sheet Form

This form must be attached to the Virginia Name Change Petition prior filing. Attending staff will collect a filing fee upon submission of the petition.Download

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COVER SHEET FOR FILING CIVIL ACTIONS	 Case No. 	........................................................................\
.......	 	COMMONWEALTH OF VIRGINIA  (CLERK’S OFFICE USE ONLY) 
 
........................................................................\
...............................................................................................................................\
..........................	
 Circuit Court 	 ........................................................................\
........................................................... 	
v./ In re:	 .......................................................................\
..................................................  	 PLAINTIFF(S)  DEFENDANT(S)  ........................................................................\
........................................................... ...................................................................\
......................................................   
I, the undersigned [  ] plaintiff [  ] defendant [  ] attorney for [  ] plaintiff [  ] defendant hereby notify the Clerk of Cou rt that I am filing 
the following civil action. (Please indicate  by checking box that most closely identifies the claim being asserted or relief sought.) 
 
GENERAL CIVIL  
Subsequent Actions  
[  ]  Claim Impleading Third Party Defendant  
[  ]  Monetary Damages 
[  ]  No Monetary Damages 
[  ]  Counterclaim 
[  ]  Monetary Damages 
[  ]  No Monetary Damages 
[  ]  Cross Claim 
[  ]  Interpleader 
[  ]  Reinstatement (other than divorce or  driving pr
 ivileges) 
[  ]  Removal of Case to Federal Court 
Business & Contract  
[  ]  Attachment 
[  ]  Confessed Judgment 
[  ]  Contract Action 
[  ]  Contract Specific Performance 
[  ]  Detinue 
[  ]  Garnishment 
Property  
[  ]  Annexation 
[  ]  Condemnation 
[  ]  Ejectment 
[  ]  Encumber/Sell Real Estate 
[  ]  Enforce Vendor’s Lien 
[  ]  Escheatment 
[  ]  Establish Boundaries 
[  ]  Landlord/Tenant 
[  ]  Unlawful Detainer 
[  ]  Mechanics Lien 
[  ]  Partition 
[  ]  Quiet Title 
[  ]  Termination of Mineral Rights 
Tort  
[  ]  Asbestos Litigation 
[  ]  Compromise Settlement 
[  ]  Intentional Tort 
[  ]  Medical Malpractice 
[  ]  Motor Vehicle Tort 
[  ]  Product Liability 
[  ]  Wrongful Death 
[  ]  Other General Tort Liability 	
ADMINISTRATIVE LAW  
[  ]  Appeal/Judicial Review of Decision of 
(select one) 
[  ]  ABC Board 
[  ]  Board of Zoning 
[  ]  Compensation Board 
[  ]  DMV License Suspension 
[  ]  Employee Grievance Decision 
[  ]  Employment Commission 
[  ]  Local Government 
[  ]  Marine Resources Commission 
[  ]  School Board 
[  ]  Voter Registration 
[  ]  Other Administrative Appeal 
 
DOMESTIC/FAMILY 
[  ]  Adoption  [  ]  Adoption – Foreign 
[  ]  Adult Protection 
[  ]  Annulment  [  ]  Annulment – Counterclaim/Responsive P	
 leading 
[  ]  Child Abuse and Neglect – Unfounded 
Com	
 plaint 
[  ]  Civil Contempt 
[  ]  Divorce (select one)  [  ]  Complaint – Contested* 
[  ]  Complaint – Uncontested* 
[  ]  Counterclaim/Responsive Pleading 
[  ]  Reinstatement – Custod	
 y/Visitation/Support/Equitable 
Distribution 
[  ]  Separate Maintenance 
[  ]  Separate Main tenance Counterclaim 
 	
WRITS 
[  ]  Certiorari 
[  ]  Habeas Corpus 
[  ]  Mandamus 
[  ]  Prohibition 
[  ]  Quo Warranto 	
PROBATE/WILLS AND TRUSTS  
[  ]  Accounting 
[  ]  Aid and Guidance 
[  ]  Appointment (select one) 
[  ]  Guardian/Conservator 
[  ]  Standby Guardian/Conservator 
[  ]  Trust (select one)  [  ]  Impress/Declare 
[  ]  Reformation 
[  ]  Will (select one) 
[  ]  Construe 
[  ]  Contested 
 
MISCELLANEOUS  
[  ]  Appointment (select one) 
[  ]  Church Trustee 
[  ]  Conservator of Peace 
[  ]  Marriage Celebrant 
[  ]  Bond Forfeiture Appeal 
[  ]  Declaratory Judgment 
[  ]  Declare Death 
[  ]  Driving Privileges (select one)  [  ]  Reinstatement pursuant to § 46.2-427 
[  ]  Restoration – Habitual Offender or 3	
rd 
Offense 
[  ]  Expungement 
[  ]  Firearms Rights – Restoration 
[  ]  Forfeiture of U.S. Currency 
[  ]  Freedom of Information 
[  ]  Injunction 
[  ]  Interdiction 
[  ]  Interrogatory 
[  ]  Judgment Lien-Bill to Enforce 
[  ]  Law Enforcement/Public Official Petition 
[  ]  Name Change 
[  ]  Referendum Elections 
[  ]  Sever Order 
[  ]  Taxes (select one)  [  ]  Correct Erroneous State/Local 
[  ]  Delinquent 
[  ]  Vehicle Confiscation 
[  ]  Voting Rights – Restoration 
[  ]  Other (please specify) 	
 	 
 .......................................................................\
........ 
 	
[  ]  Damages in the amount of $ 	.................................................................	 are claimed. 	 
 
.......................................................................  
_____________________________________________________________________  DATE 	[  ] 	PLAINTIFF 	[  ] 	DEFENDANT 	[  ] 	ATTORNEY FOR 	[  ] 	PLAINTIFF 
 	[  ] 	DEFENDANT 	 ........................................................................\
........................................................................  	*“Contested” divorce means any of the following matters are in 
dispute:  grounds of divorce, sp ousal support and maintenance, 
child custody and/or visitation, child support, property distribution 
or debt allocation.  An “Uncontes ted” divorce is filed on no fault 
grounds and none of the above issues are in dispute. 	 PRINT  NAME  ........................................................................\
........................................................................   ADDRESS/TELEPHONE NUMBER OF SIGNATOR	 
 
........................................................................\
........................................................................

FORM CC-1416 (MASTER) PAGE TWO 10/12	 Civil Action Type Codes 
(Clerk’s Office Use Only) 	
 
 
Accounting 	
........................................................................\
.....	ACCT 
Adoption 	
........................................................................\
.........	ADOP 
Adoption – Foreign 	
............................................................	FORA 
Adult Protection 	
....................................................................	PROT 
Aid and Guidance 	
....................................................................	AID 
Annexation 	
........................................................................\
...	 ANEX 
Annulment 	
........................................................................\
....	ANUL 
Annulment – Counterclaim/Responsive Pleading
...ACRP 
Appeal/Judicial Review 
ABC Board 	
......................................................................	ABC 
Board of Zoning 	
.........................................................	ZONE 
Compensation Board 	
..............................................	ACOM 
DMV License Suspension 	
..............................................	JR 
Employment Commission 	
.........................................	EMP 
Employment Grievance Decision 	
...........................	GRV 
Local Government 	
....................................................	GOVT 
Marine Resources 	
........................................................	MAR 
School Board 	
.......................................................................	JR 
Voter Registration 	
.....................................................	AVOT 
Other Administrative Appeal 	
................................	AAPL 
Appointment 
Conservator of Peace 	
....................................................	COP 
Church Trustee 	
............................................................	AOCT 
Guardian/Conservator 	
...............................................	APPT 
Marriage Celebrant 	
...................................................	ROMC 
Standby Guardian/Conservator 	
............................	STND 
Asbestos Litigation 	
....................................................................	AL 
Attachment 	
........................................................................\
.........	ATT 
Bond Forfeiture Appeal 	
........................................................	BFA 
Child Abuse and Neglect – Unfounded Complaint 
..CAN 
Civil Contempt 	
....................................................................	CCON 
Claim Impleading Third Party Defendant –  
  Monetary Damages/No Monetary Damages 	
...........	CTP 
Complaint – (Miscellaneous) 	
...........................................	COM 
Compromise Settlement 	
..................................................	COMP 
Condemnation 	
.....................................................................	COND 
Confessed Judgment 	
..................................................................	CJ 
Contract Action 	
....................................................................	CNTR 
Contract Specific Performance 	
.......................................	PERF 
Counterclaim – Monetary Damages/No Monetary  Damages 	
........................................................................\
............	CC 
Cross Claim 	
........................................................................\
...	CROS 
Declaratory Judgment 	
.......................................................	DECL 
Declare Death 	
......................................................................	DDTH 
Detinue 	
........................................................................\
................	DET 
Divorce  Complaint – Contested/Uncontested 	
.......................	DIV 
Counterclaim/Responsive Pleading 	
....................	DCRP 
Reinstatement – Custody/Visitation/Support/ 
Equitable Distribution 	
.............................................	CVS 
Driving Privileges  Reinstatement pursuant to § 46.2-427 	
................	DRIV 
Restoration – Habitual Offender or   3	
rd Offense 	.................................................................	REST  Ejectment 	
........................................................................\
..........	EJCT 
Encumber/Sell Real Estate 	
.....................................................	RE 
Enforce Vendor’s Lien 	
.....................................................	VEND 
Escheatment 	
........................................................................\
.......	ESC 
Establish Boundaries 	
...........................................................	ESTB 
Expungement 	
........................................................................\
	XPUN 
Firearms Rights – Restoration 	
.........................................	REST 
Forfeiture of U.S. Currency 	
.............................................	FORF 
Freedom of Information 	
.........................................................	FOI 
Garnishment 	
........................................................................\
..	GARN 
Injunction 	
........................................................................\
..............	INJ 
Intentional Tort 	
......................................................................	ITOR 
Interdiction 	
........................................................................\
......	INTD 
Interpleader 	
........................................................................\
......	INTP 
Interrogatory 	
........................................................................\
...	INTR 
Judgment Lien – Bill to Enforce 	
.....................................	LIEN 
Landlord/Tenant 	
........................................................................\
..	LT 
Law Enforcement/Public Official Petition 	
....................	LEP 
Mechanics Lien 	
..................................................................	MECH 
Medical Malpractice 	
.............................................................	MED 
Motor Vehicle Tort 	
..................................................................	MV 
Name Change 	
........................................................................\
......	NC 
Other General Tort Liability 	
..........................................	GTOR 
Partition 	
........................................................................\
...........	PART 
Petition – (Miscellaneous) 	
...................................................	PET 
Product Liability 	
..................................................................	PROD 
Quiet Title 	
........................................................................\
.............	QT 
Referendum Elections 	
........................................................	ELEC 
Reinstatement (Other than divorce or driving 
privileges) 	
........................................................................\
...	REIN 
Removal of Case to Federal Court 	
.................................	REM 
Separate Maintenance 	
............................................................	SEP 
Separate Maintenance – Counterclaim/Responsive  Pleading 	
........................................................................\
.......	SCRP 
Sever Order 	
........................................................................\
....	SEVR 
Taxes  Correct Erroneous State/Local 	
.............................	CTAX 
Delinquent 	
....................................................................	DTAX 
Termination of Mineral Rights 	
.........................................	MIN 
Trust – Impress/Declare 	
.....................................................	TRST 
Trust – Reformation 	
............................................................	REFT 
Unlawful Detainer 	
.....................................................................	UD 
Vehicle Confiscation 	
.............................................................	VEH 
Voting Rights – Restoration 	
............................................	VOTE 
Will Construction 	
................................................................	CNST 
Will Contested 	
......................................................................	WILL 
Writs 
Certiorari 	
........................................................................\
.....	WC 
Habeas Corpus 	
..............................................................	WHC 
Mandamus 	
........................................................................\
.	WM 
Prohibition 	
........................................................................\
..	WP 
Quo Warranto 	
..............................................................	WQW 
Wrongful Death 	
........................................................................\
.	WD