FOR REFERENCE ONLY 265 DC Forms List
User Manual: 265 DC
Open the PDF directly: View PDF 
.
Page Count: 21
| Download | |
| Open PDF In Browser | View PDF |
COMMONWEALTH OF VIRGINIA DISTRICT COURT FORMS LISTING FOR REFERENCE ONLY: This is a list of District Court Forms produced by the Office of the Executive Secretary including their current revision dates. The list includes forms for public use and forms used by court personnel only. Not all forms on this list are available and you cannot link to the revisable Internet forms from this listing. MISCELLANEOUS FORMS Form # DC-25 DC-30 Form Name CIRCUIT COURT CASE TRANSMITTAL AND FEES REMITTANCE SHEET COMMONWEALTH OF VIRGINIA DRIVER’S LICENSE REINSTATEMENT FORM Form Type Revision Date Master 07/15 Master 12/05 DC-32 DELINQUENT PAYMENT RECORD Master 10/14 DC-33 DELINQUENT COLLECTIONS REPORT Master 05/09 DC-40 LIST OF ALLOWANCES Printed DC-40(a) APPLICATION AND AUTHORIZATION FOR WAIVER OF FEE CAP Master DC-42 LIST OF ALLOWANCES FOR COMMONWEALTH WITNESS Printed 10/89 DC-43 LIST OF ALLOWANCES FOR JURORS Printed 12/88 DC-43(c) LIST OF ALLOWANCES FOR JURORS – CONTINUATION SHEET Printed 12/88 DC-44 LIST OF ALLOWANCES – INTERPRETER Printed 10/17 (front) 07/08 (reverse) DC-52 PUBLIC DEFENDER TIMESHEET Printed 07/01 DC-60 INVOLUNTARY ADMISSION HEARING INVOICE Printed 07/08 (front) 07/16 (reverse) DC-90 ORDER DESIGNATING DISTRICT COURT JUDGE, RETIRED JUDGE OR SUBSTITUTE JUDGE TO PRESIDE IN A DISTRICT COURT Master 10/08 DC-91 ORDER OF DISQUALIFICATION/WAIVER OF DISQUALIFICATION Master 12/01 COURT CASE FORMS – TRAFFIC Form # Form Name DC-201 11/16 (front) 10/15 (reverse) 01/08 (p. 1) 04/13 (p. 2) DC-200S Form Type Revision Date NOTICE OF ADMINISTRATIVE SUSPENSION OF DRIVER’S LICENSE/DRIVING PRIVILEGE Printed 03/17 (front) 11/06 (reverse) DC-202 MOTION FOR REVIEW OF ADMINISTRATIVE SUSPENSION OF DRIVER’S LICENSE/DRIVING PRIVILEGE Master 10/08 DC-210 ACKNOWLEDGEMENT OF SUSPENSION OR REVOCATION OF DRIVER’S LICENSE Printed 10/17 (front) 10/17 (reverse) DC-211 PETITION FOR PAYMENT AGREEMENT FOR FINES AND COSTS OR MOTION TO MODIFY EXISTING AGREEMENT Master Page 1, 07/17 Page 2, 07/17 DC-215 NOTICE OF DISHONORED CHECK OR CREDIT CARD CHARGE Master 11/06 Revised 10/2017 Page 1 of 21 COMMONWEALTH OF VIRGINIA COURT CASE FORMS – TRAFFIC Form # Form Name DC-216 DISTRICT COURT FORMS LISTING DC-200S Form Type Revision Date COMPLIANCE WITH LAW CERTIFICATE Master 07/17 DC-217 VIRGINIA PREPAYABLE OFFENSES INFORMATION SHEET Printed 07/17 (front) 10/12 (reverse) DC-224 NOTICE TO PAY Master 10/12 (p. 1) 07/13 (p. 2) DC-224 NOTICE TO PAY (letter format only) Printed 07/13 DC-225 NOTICE TO PAY AND NOTICE OF SUSPENSION FOR FAILURE TO PAY Printed 11/16 (front) 11/16 (reverse) DC-225 NOTICE TO PAY AND NOTICE OF SUSPENSION FOR FAILURE TO PAY (letter format only) Printed 10/17 DC-231 CERTIFICATE OF REFUSAL – BLOOD/BREATH TEST WATERCRAFT OR MOTORBOATS Master 07/07 (p. 1) 07/07 (p. 2) DC-232 CERTIFICATE OF REFUSAL – BLOOD/BREATH TEST COMMERCIAL MOTOR VEHICLE Master 03/17 DC-233 DECLARATION AND ACKNOWLEDGEMENT OF REFUSAL – BLOOD/BREATH TEST Printed 07/17 Printed 07/17 (p. 1, front) 07/10 (p. 1, reverse) 07/17 (p. 2) 07/17 (p. 3) DC-260 DRIVER’S LICENSE FORFEITURE/SUSPENSION AND RESTRICTED DRIVING ORDER (DC-261 is pages two and three of DC-260, DC-265, DC-279, DC-282, DC-359, DC-576 & DC-577) RESTRICTED LICENSE ORDER DC-261 (DC-261 is pages two and three of DC-260, DC-265, DC-279, DC-282, DC-359, DC-576 & DC-577) Printed 07/17 (p.1) 07/17 (p. 2) DC-262 ORDER TO ENTER INTO PROGRAM Master 10/12 DC-263 APPLICATION FOR RESTRICTED DRIVER’S LICENSE Master 10/13 (p. 1) 07/17 (p. 2) DC-265 RESTRICTED DRIVER’S LICENSE ORDER AND ENTRY INTO ALCOHOL SAFETY ACTION PROGRAM DC-266 RESTRICTED LICENSE CONDITIONS – IGNITION INTERLOCK ORDER Printed DC-267 OUT OF SERVICE ORDER – DRIVER Master 07/17 DC-270 PETITION FOR AUTHORIZATION FOR RESTRICTED DRIVER’S LICENSE – FAILURE TO PAY FINES AND COSTS Printed 07/17 (front) 07/17 (reverse) DC-271 AUTHORIZATION FOR RESTRICTED DRIVER’S LICENSE – FAILURE TO PAY FINES AND COSTS Printed 07/17 (front) 07/08 (reverse) DC-273 PETITION FOR AUTHORIZATION FOR RESTRICTED DRIVER’S LICENSE – CONVICTION FOR UNAUTHORIZED DRIVING Master 10/09 (p. 1) 07/17 (p. 2) DC-274 AUTHORIZATION FOR RESTRICTED DRIVER’S LICENSE – CONVICTION FOR UNAUTHORIZED DRIVING Printed 07/17 (front) 11/10 (reverse) DC-276 PETITION AND ORDER FOR APPROVAL OF JAIL FEES PAYMENT AGREEMENT Master 07/12 (p. 1) 07/12 (p. 2) (DC-261 is pages two and three of DC-260, DC-265, DC-279, DC-282, DC-359, DC-576, & DC-577) Revised 10/2017 Printed 07/17 (p. 1, front) 07/10 (p. 1, reverse) 07/17 (p. 2) 07/17 (p. 3) 10/17 (front) 07/12 (reverse) Page 2 of 21 COMMONWEALTH OF VIRGINIA COURT CASE FORMS – TRAFFIC Form # Form Name DC-277 DC-278 DISTRICT COURT FORMS LISTING DC-200S Form Type Revision Date PETITION AND ORDER AUTHORIZING SUSPENSION OR NONRENEWAL OF DRIVER'S LICENSE – FAILURE TO PAY JAIL FEE Master 07/12 (p. 1) 07/12 (p. 2) PETITION FOR RESTRICTED DRIVER'S LICENSE – FAILURE TO PAY JAIL FEE Master 07/17 Printed 07/17 (p. 1, front) 07/12 (p.1, reverse) 07/17 (p. 2) 07/17 (p. 3) RESTRICTED DRIVER'S LICENSE ORDER – FAILURE TO PAY JAIL FEE DC-279 (DC-261 is pages two and three of DC-260, DC-265, DC-279, DC-282, DC-359, DC-576, & DC-577) DC-280 PETITION AND ORDER TO SUSPEND DRIVER’S LICENSE – FAILURE TO PAY CHILD SUPPORT Master 07/15 DC-281 PETITION FOR RESTRICTED DRIVER’S LICENSE – FAILURE TO PAY CHILD SUPPORT Master 07/17 Printed 07/17 (p. 1, front) 10/08 (p.1, reverse) 07/17 (p. 2) 07/17 (p. 3) DC-282 RESTRICTED DRIVER’S LICENSE ORDER – FAILURE TO PAY CHILD SUPPORT DC-284 MOTION TO DISMISS TOLL ROAD SUMMONS Master 07/11 DC-285 SUMMONS FOR TOLL ROAD OR DESIGNATED ACCESS HIGHWAY VIOLATION Master 11/16 (p. 1) 11/16 (p. 2) DC-286 DISPOSITION ORDER – UNIFORM SUMMONS Master 10/17 DC-287 SUMMONS FOR HIGH-OCCUPANCY TOLL (HOT) LANE VIOLATION Master 11/16 (p. 1) 11/16 (p. 2) (DC-261 is pages two and three of DC-260, DC-265, DC-279, DC-282, DC-359, DC-567 & DC-577) COURT CASE FORMS – CRIMINAL Form # Form Name DC-301 DC-300S Form Type Revision Date REQUEST FOR CONFIDENTIALITY BY CRIME VICTIM Master 07/14 DC-302 REQUEST FOR COPY OF CERTIFICATE OF ANALYSIS Master 10/08 DC-303 MOTION FOR TRANSMISSION OF BLOOD SAMPLE Master 07/05 DC-304 NOTICE, MOTION AND ORDER FOR CHEMICAL ANALYSIS OF ALLEGED PLANT MATERIAL Printed 10/08 DC-305 OBJECTION TO ADMISSION OF CERTIFICATE OF ANALYSIS/VIDEO TESTIMONY Master 07/10 DC-306 OBJECTION TO ADMISSION OF AFFIDAVIT Master 07/10 DC-307 CERTIFICATE FOR THE USE OF CANNABIDIOL OIL OR THC-A OIL Master 03/17 DC-308 AFFIDAVIT FOR SEARCH WARRANT FOR REAL-TIME LOCATION DATA Master 07/17 (p. 1) 07/15 (p. 2) DC-309 SEARCH WARRANT FOR REAL-TIME LOCATION DATA Master 07/15 (p. 1) 07/15 (p. 2) Revised 10/2017 Page 3 of 21 COMMONWEALTH OF VIRGINIA COURT CASE FORMS – CRIMINAL Form # Form Name DC-310 DISTRICT COURT FORMS LISTING DC-300S Form Type Revision Date CRIMINAL COMPLAINT (BAD CHECK) Printed 07/11 DC-311 CRIMINAL COMPLAINT Printed 07/11 DC-312 WARRANT OF ARREST – FELONY Master 10/13 (p. 1) 10/17 (p. 2) DC-314 WARRANT OF ARREST – MISDEMEANOR (STATE) Master 07/11 (p. 1) 10/17 (p. 2) DC-315 WARRANT OF ARREST – MISDEMEANOR (LOCAL) Master 07/11 (p. 1) 10/17 (p. 2) DC-317 ORDER FOR RESTITUTION Master, Printed Page 1, 10/17 Page 2, 07/17 DC-317-S1 SUPPLEMENTAL SHEET TO ORDER FOR RESTITUTION FOR VICTIM INFORMATION Master, Printed 07/17 DC-317-S2 SUPPLEMENTAL SHEET TO ORDER FOR RESTITUTION FOR CODEFENDANT INFORMATION Master, Printed 10/17 DC-319 SUMMONS Master 07/11 (p. 1) 10/17 (p. 2) DC-320 WARRANT OF ARREST – ILLEGAL ALIEN PURSUANT TO 19.2-81.6 Master 07/04 DC-321 SUMMONS OF CORPORATION OR LEGAL ENTITY – MISDEMEANOR OR FELONY Master 10/09 DC-322 ORDER – TRANSFER OF JURISDICTION Master 07/92 DC-323 RECALL OF PROCESS Printed 10/17 DC-324 NOTICE – APPEARANCE, WAIVER AND PLEA Master 05/07 DC-325 REQUEST FOR WITNESS SUBPOENA Printed 10/08 DC-326 SUBPOENA FOR WITNESS Printed 10/08 (front) 07/14 (reverse) DC-326x SUBPOENA FOR WITNESS (continuous paper) Printed 10/08 (front) 07/14 (reverse) DC-327 CHECKLIST FOR BAIL DETERMINATIONS Printed 07/13 (front) 07/15 (reverse) DC-328 MOTION AND ORDER TO TRY DEFENDANT FOR A MISDEMEANOR WITHOUT APPOINTMENT OF COUNSEL Master 07/14 DC-329 RECOGNIZANCE (WITNESS) Printed 07/11 DC-330 RECOGNIZANCE Master 10/11 (p. 1) 10/13 (p. 2) 07/12 (p. 3) DC-331 SURETY’S CAPIAS AND BAILPIECE RELEASE Printed 07/14 Revised 10/2017 Page 4 of 21 COMMONWEALTH OF VIRGINIA COURT CASE FORMS – CRIMINAL Form # Form Name DC-332 DISTRICT COURT FORMS LISTING DC-300S Form Type Revision Date AFFIDAVIT FOR SURETY Printed 11/07 DC-333 FINANCIAL STATEMENT – ELIGIBILITY DETERMINATION FOR INDIGENT DEFENSE SERVICES Printed 10/11 DC-334 REQUEST FOR APPOINTMENT OF A LAWYER Printed 11/06 DC-335 WAIVER OF RIGHT TO REPRESENTATION BY A LAWYER Printed 07/14 DC-336 SUBPOENA DUCES TECUM Printed 06/06 (front) 07/04 (reverse) DC-338 AFFIDAVIT FOR SEARCH WARRANT Master 07/17 (p. 1) 07/17 (p. 2) DC-339 SEARCH WARRANT Master 07/17 (p. 1) 01/09 (p. 2) DC-340 AFFIDAVIT FOR SEARCH WARRANT FOR TRACKING DEVICE Master 07/12 (p. 1) 07/14 (p. 2) DC-341 SEARCH WARRANT FOR TRACKING DEVICE Master 04/12 (p. 1) 04/12 (p. 2) DC-342 ORDER FOR PSYCHOLOGICAL EVALUATION Master 07/14 (p. 1) 07/10 (p. 2) DC-343 TRACKING DOCUMENT FOR SENDING OR RECEIVING EVALUATION OR TREATMENT ORDER UPON ENTRY Master 07/16 DC-344 MOTION TO WAIVE COURT APPEARANCE Master 10/13 DC-345 ORDER FOR TREATMENT OF INCOMPETENT DEFENDANT Master 10/17 DC-346 NOTICE OF HEARING DATE Printed 12/84 DC-346 NOTICE OF HEARING DATE (letter format only) Printed 11/10 DC-347 CONTINUANCE CARD NOTICE/APPEARANCE REMINDER NOTICE Printed 11/92 DC-348 NOTICE TO INDIVIDUAL – SUBPOENA DUCES TECUM FOR MEDICAL RECORDS Master 07/04 DC-349 NOTICE OF OPPORTUNITY TO HIRE COUNSEL AND/OR INELIGIBILITY FOR APPOINTED COUNSEL; ORDER Printed 07/14 DC-350 NOTICE TO HEALTH CARE PROVIDERS – SUBPOENA DUCES TECUM FOR MEDICAL RECORDS Master 07/04 DC-351 CHARGE ADDENDUM Master 10/13 DC-352 COMMITMENT ORDER Master 05/09 (p. 1) 07/13 (p. 2) DC-353 RELEASE ORDER Master 05/09 Revised 10/2017 Page 5 of 21 COMMONWEALTH OF VIRGINIA COURT CASE FORMS – CRIMINAL Form # Form Name DC-354 DISTRICT COURT FORMS LISTING DC-300S Form Type Revision Date CUSTODIAL TRANSPORTATION ORDER Master 05/09 DC-355 ORDER FOR CONTINUED CUSTODY Printed 07/11 DC-356 DISPOSITION NOTICE Printed 10/17 DC-356-A DISPOSITION NOTICE ADDENDUM Master 03/08 DC-357 ORDER REGARDING SUBSTANCE ABUSE SCREENING – ADULT MISDEMEANOR Master 10/08 DC-358 ENTRY INTO ALCOHOL REHABILITATION PROGRAM (BOAT) Master 10/08 DC-359 FORFEITURE OF DRIVER’S LICENSE AND RESTRICTED DRIVER’S LICENSE ORDER – DRUG VIOLATION Printed 07/17 (p. 1, front) 07/10 (p. 1, reverse) 07/17 (p. 2) 07/17 (p. 3) DC-360 SHOW CAUSE SUMMONS (CRIMINAL) Master 10/14 (p. 1) 11/16 (p. 2) DC-360x SHOW CAUSE SUMMONS (CRIMINAL) continuous paper Printed 10/14 (front) 11/16 (reverse) DC-361 CAPIAS – ATTACHMENT OF THE BODY Master 10/14 (p. 1) 11/16 (p. 2) DC-361x CAPIAS – ATTACHMENT OF THE BODY continuous paper Printed 10/14 (front) 11/16 (reverse) DC-362 MOTION AND AFFIDAVIT REQUESTING COSTS FOR COMPUTER FORENSIC ANALYSIS Master 07/11 DC-363 PETITION OR MOTION FOR EXPUNGEMENT Master 05/15 DC-364 RECOGNIZANCE AND BOND TO KEEP THE PEACE Master 10/15 (p. 1) 07/12 (p. 2) DC-365 EXPUNGEMENT ORDER Master 07/11 DC-366 CERTIFICATE OF INCARCERATION PERIOD Master 07/16 DC-366A REQUEST FOR WAIVER OF INTEREST OF FINES AND COSTS Master 07/16 Master 10/17 Printed 10/11 (front) 06/06 (reverse) DC-367 DC-368 DC-261 is pages two and three of DC-260, DC-265, DC-279, DC-282, DC-359, DC-576 & DC-577) APPLICATION, REQUEST, ORDER AND CERTIFICATE OF DESTRUCTION OF CONTROLLED/CONFISCATED ITEMS MOTION TO REOPEN (CRIMINAL)/MOTION TO REHEAR (CIVIL)/ MOTION FOR NEW TRIAL (CIVIL) (the reverse side of DC-368 is the reverse for DC-433 & DC-434) DC-370 NOTICE OF APPEAL – CRIMINAL Printed 11/16 DC-371 MOTION AND NOTICE OF HEARING Master 10/12 (p. 1) 05/09 (p. 2) Revised 10/2017 Page 6 of 21 COMMONWEALTH OF VIRGINIA COURT CASE FORMS – CRIMINAL Form # Form Name DC-372 DISTRICT COURT FORMS LISTING DC-300S Form Type Revision Date AUTHENTICATION OF RECORD (in-state usage) Master 10/07 DC-373 NOTICE OF ISSUANCE OF EMERGENCY PROTECTIVE ORDER Printed DC-374 WARRANT OF ARREST FOR EXTRADITION Master DC-375 WAIVER OF EXTRADITION PROCEEDINGS Master 10/07 DC-376 AFFIDAVIT FOR FIRE INVESTIGATION WARRANT Master 07/17 DC-377 FIRE INVESTIGATION WARRANT Master 07/14 DC-378 AFFIDAVIT FOR DAM INSPECTION WARRANT Master 07/17 DC-379 DAM INSPECTION WARRANT Master 07/14 DC-380 AFFIDAVIT FOR FIRE INSPECTION WARRANT Master 07/17 (p. 1) 07/14 (p. 2) DC-381 FIRE INSPECTION WARRANT Master DC-382 EMERGENCY PROTECTIVE ORDER Printed DC-383 PETITION FOR PROTECTIVE ORDER Master DC-384 PRELIMINARY PROTECTIVE ORDER Master 07/14 (p. 1) 04/13 (p. 2) DC-385 PROTECTIVE ORDER Master 10/14 (p. 1) 10/12 (p. 2) DC-386 AFFIDAVIT FOR PESTICIDE CONTROL ADMINISTRATIVE SEARCH WARRANT Master 07/17 (p. 1) 07/14 (p. 2) DC-387 PESTICIDE CONTROL ADMINISTRATIVE SEARCH WARRANT Master 07/14 (p. 1) 05/00 (p. 2) DC-388 AFFIDAVIT FOR RELEASE OF HAZARDOUS MATERIAL OR WASTE OR REGULATED SUBSTANCE INVESTIGATION WARRANT Master 07/17 (p. 1) 07/14 (p. 2) DC-389 RELEASE OF HAZARDOUS MATERIAL OR WASTE OR REGULATED SUBSTANCE INVESTIGATION WARRANT Master 07/14 DC-390 AFFIDAVIT FOR BUILDING INSPECTION WARRANT Master 07/17 (p. 1) 07/14 (p. 2) DC-391 BUILDING INSPECTION WARRANT Master 07/14 (p. 1) 07/01 (p. 2) DC-392 SEALED DOCUMENTS Printed 05/03 Revised 10/2017 11/16 (p. 1, front) 11/16 (p. 1&4, reverse) 11/16 (p. 2&3, reverse) 07/05 (p. 1) 07/05 (p. 2) 07/14 (p. 1) 05/88 (p. 2) 07/16 (p. 1, front) 07/16 (p.1 & 4, reverse) 07/16 (p.2 & 3, reverse) 10/14 (p. 1) 04/13 (p. 2) Page 7 of 21 COMMONWEALTH OF VIRGINIA COURT CASE FORMS – CRIMINAL Form # Form Name DC-393 DISTRICT COURT FORMS LISTING DC-300S Form Type Revision Date PETITION FOR HIV OR HEPATITIS B OR C VIRUSES TESTING PURSUANT TO 18.2-62 Master 01/09 DC-394 DENIAL/DISMISSAL ORDER IN PROTECTIVE ORDER CASES Master 10/11 (p.1) 10/11 (p.2) DC-395 AFFIDAVIT FOR SUMMONS FOR DANGEROUS DOG OR VICIOUS DOG Master 07/13 DC-396 SUMMONS – DANGEROUS DOG OR VICIOUS DOG Master 10/13 (p. 1) 07/17 (p. 2) DC-397 AFFIDAVIT FOR WARRANT FOR DEPREDATION BY DOG Master 07/16 DC-398 WARRANT – DEPREDATION BY DOG Master 07/16 (p. 1) 07/16 (p. 2) DC-399 SEARCH WARRANT – CRUELTY TO ANIMALS Master 07/14 COURT CASE FORMS – CIVIL Form # Form Name DC-400 DC-400S Form Type Revision Date MEDIATION ORIENTATION ORDER OF REFERRAL Master 10/07 (p. 1) 10/08 (p. 2) DC-401 ORDER FOR APPOINTMENT OF GUARDIAN AD LITEM Master 07/97 DC-402 WARRANT IN DEBT – SMALL CLAIMS DIVISION Printed 10/07 (front) 07/01 (reverse) DC-404 WARRANT IN DETINUE – SMALL CLAIMS DIVISION Master 05/08 (p. 1) 05/08 (p. 2) DC-405 PETITION TO TEST FOR BLOOD – BORNE PATHOGENS Master 07/08 (p. 1) 10/97 (p. 2) DC-406 PETITION TO REQUIRE BLOOD TEST Master 07/15 (p. 1) 10/12 (p. 2) DC-407 REQUEST FOR HEARING – EXEMPTION CLAIM Printed 07/15 (front) 07/12 (reverse) DC-410 AFFIDAVIT FOR SERVICE OF PROCESS ON THE SECRETARY OF THE COMMONWEALTH Printed 07/13 (front) 11/07 (reverse) DC-411 SERVICE OTHER THAN BY VIRGINIA SHERIFF Master 10/08 DC-412 WARRANT IN DEBT Printed 07/04 (front) 07/04 (reverse) DC-412x WARRANT IN DEBT (continuous paper) Printed 07/04 (front) 07/04 (reverse) DC-413 CERTIFICATE OF MAILING POSTED SERVICE Master 06/99 DC-414 WARRANT IN DETINUE Printed 07/04 (front) 07/04 (reverse) Revised 10/2017 Page 8 of 21 COMMONWEALTH OF VIRGINIA COURT CASE FORMS – CIVIL Form # Form Name DC-415 DISTRICT COURT FORMS LISTING DC-400S Form Type Revision Date DETINUE SEIZURE PETITION Master 05/04 (p. 1) 05/04 (p. 2) DC-416 DETINUE SEIZURE ORDER Master 12/00 (p. 1) 06/89 (p. 2) DC-417 ORDER FOR STAY – SERVICEMEMBERS CIVIL RELIEF ACT Master 07/16 DC-418 AFFIDAVIT – DEFAULT JUDGMENT – SERVICEMEMBERS CIVIL RELIEF ACT Printed 11/16 DC-419 MOTION AND ORDER FOR VOLUNTARY NONSUIT Master 07/07 (p. 1) 07/07 (p. 2) DC-420 MOTION FOR SHOW CAUSE SUMMONS OR CAPIAS (General District) Printed 10/08 DC-421 SUMMONS FOR UNLAWFUL DETAINER Printed 10/17 (front) 10/17 (reverse) DC-422 NOTICE OF HEARING TO ESTABLISH FINAL RENT AND DAMAGES Master 07/14 DC-423 DISTRESS PETITION Master 07/09 (p. 1) 07/93 (p. 2) DC-424 DISTRESS WARRANT Master 10/07 (p. 1) 06/89 (p. 2) DC-428 WARRANT IN DEBT – INTERPLEADER Master 07/10 (p. 1) 10/07 (p. 2) DC-429 TENANT’S ASSERTION AND COMPLAINT Master 07/16 (p. 1) 10/15 (p. 2) DC-430 SUMMONS FOR HEARING Master 10/15 (p. 1) 06/95 (p. 2) DC-431 TENANT’S PETITION FOR RELIEF FROM UNLAWFUL EXCLUSION Master 07/13 (p. 1) 07/13 (p. 2) DC-432 AFFIDAVIT FOR SUMMONS IN INTERPLEADER Master 11/10 DC-433 SUMMONS IN INTERPLEADER AND ORDER FOR POSTPONEMENT OF SALE Master 06/89 (p. 1) 06/06 (p. 2) Master 10/11 (front) 06/06 (reverse) DC-434 MOTION TO SET ASIDE DEFAULT JUDGMENT (the reverse side of DC-368 is the reverse for DC-433 & DC-434) DC-435 AFFIDAVIT AND PETITION FOR ORDER OF PUBLICATION Master 11/10 DC-436 ORDER OF PUBLICATION Master 07/15 DC-437 NOTICE OF CHANGE OF ADDRESS Master 10/08 DC-440 SUMMONS TO ANSWER INTERROGATORIES AND WRIT OF FIERI FACIAS Printed 10/17 (front) 07/03 (reverse) DC-441 BILL OF PARTICULARS Master 05/09 Revised 10/2017 Page 9 of 21 COMMONWEALTH OF VIRGINIA COURT CASE FORMS – CIVIL Form # Form Name DC-442 DISTRICT COURT FORMS LISTING DC-400S Form Type Revision Date GROUNDS OF DEFENSE Master 05/09 DC-443 ITEMIZED LIST OF DAMAGES Master 05/09 DC-445 ATTACHMENT PETITION Master 07/15 (p. 1) 07/93 (p. 2) DC-446 ATTACHMENT SUMMONS Master 07/11 (p. 1) 06/89 (p. 2) DC-447 PLAINTIFF’S BOND FOR LEVY OR SEIZURE Master 07/93 DC-448 DEFENDANT’S BOND FOR LEVY OR SEIZURE Master 07/93 DC-449 AFFIDAVIT CONCERNING DEPENDENT CHILDREN AND HOUSEHOLD INCOME Master 07/09 DC-450 SUGGESTION FOR SUMMONS IN GARNISHMENT Printed 07/12 (front) 04/84 (reverse) DC-451 GARNISHMENT SUMMONS Printed 01/07 (front) 01/07 (reverse) DC-451a GARNISHMENT STATUTE Master 10/11 DC-453 GARNISHMENT DISPOSITION Master 10/13 DC-454 REQUEST FOR HEARING – GARNISHMENT/LIEN EXEMPTION CLAIM Printed 07/10 (front) 07/12 (reverse) DC-455 GARNISHEE INFORMATION SHEET Printed 10/11 (front) 10/15 (reverse) DC-456 GARNISHEE’S ANSWER Printed 10/17 DC-458 NOTICE OF SATISFACTION Printed 07/17 DC-459 MOTION FOR JUDGMENT TO BE MARKED SATISFIED Master 07/15 (p. 1) 10/07 (p. 2) DC-460 CIVIL APPEAL BOND Master 10/11 DC-462 PLAINTIFF’S BOND – LIEN OF MECHANIC FOR REPAIRS Master 07/16 DC-463 SUMMONS – LIEN OF MECHANIC FOR REPAIRS Master 07/16 (p. 1) 06/89 (p. 2) DC-465 ABSTRACT OF JUDGMENT Master 07/07 DC-467 WRIT OF FIERI FACIAS Master 10/07 (p. 1) 03/82 (p. 2) DC-468 WRITS OF POSSESSION AND FIERI FACIAS IN DETINUE Master 05/09 (p. 1) 05/09 (p. 2) Revised 10/2017 Page 10 of 21 COMMONWEALTH OF VIRGINIA COURT CASE FORMS – CIVIL Form # Form Name DC-469 DISTRICT COURT FORMS LISTING DC-400S Form Type Revision Date REQUEST FOR WRIT OF POSSESSION IN UNLAWFUL DETAINER PROCEEDINGS Printed 11/16 DC-470 FORTHCOMING BOND Master 01/81 DC-472 PETITION FOR REINSTATEMENT OF DRIVING PRIVILEGES Master 07/03 (p. 1) 07/03 (p. 2) DC-473 ORDER FOR REINSTATEMENT OF DRIVING PRIVILEGES Master 07/03 DC-475 NOTICE OF APPEAL – CIVIL Printed 07/11 DC-476 NOTICE AND MOTION TO CURE DEFICIENCIES – CIVIL APPEAL Master 07/11 (p. 1) 11/07 (p. 2) DC-477 PETITION FOR JUDICIAL CERTIFICATION OF ELIGIBILITY FOR ADMISSION Master 07/12 DC-478 CERTIFICATION OF ELIGIBILITY FOR ADMISSION Master 07/12 DC-479 PETITION AND ORDER FOR SALE OF PROPERTY Master 07/16 (p. 1) 10/12 (p. 2) DC-480 CASE DISPOSITION Master 10/11 DC-481x SHOW CAUSE SUMMONS (CIVIL) continuous paper Printed 10/13 (front) 10/13 (reverse) DC-482 SHOW CAUSE SUMMONS (BOND FORFEITURE CIVIL) Master 10/13 (p. 1) 07/06 (p. 2) DC-483x CAPIAS: ATTACHMENT OF THE BODY (CIVIL) continuous paper Printed DC-485 PETITION FOR RESTORATION OF DRIVING PRIVILEGE – HABITUAL OFFENDER Master DC-486 ORDER FOR EVALUATION – HABITUAL OFFENDER Master 01/96 DC-487 ORDER RESTORING DRIVING PRIVILEGE – HABITUAL OFFENDER Master 07/10 (p. 1) 10/08 (p. 2) 07/17 (p. 3) DC-488 MEDICAL EMERGENCY CUSTODY ORDER Master 11/10 DC-489 MEDICAL EMERGENCY TEMPORARY DETENTION PETITION Master 07/15 DC-489A MEDICAL TREATMENT AND DETENTION PETITION Master 07/12 DC-490 MEDICAL EMERGENCY TEMPORARY DETENTION ORDER Master 07/15 (p. 1) 12/03 (p. 2) DC-490A MEDICAL TREATMENT AND DETENTION ORDER Master 07/12 Revised 10/2017 10/14 (front) 10/13 (reverse) 07/10 (p. 1) 10/07 (p. 2) 07/98 (p. 3) Page 11 of 21 COMMONWEALTH OF VIRGINIA COURT CASE FORMS – CIVIL Form # Form Name DC-491 DISTRICT COURT FORMS LISTING DC-400S Form Type Revision Date MEDICAL EMERGENCY CUSTODY PETITION Master 11/10 DC-492 EMERGENCY CUSTODY ORDER Master 07/16 (p. 1) 07/16 (p. 2) DC-493 EXPLANATION OF INVOLUNTARY COMMITMENT PROCESS – DESCRIPTION OF RIGHTS Printed 11/10 DC-494A TEMPORARY DETENTION ORDER – JUDGE Printed 07/14 (front) 07/16 (reverse) DC-495 PETITION FOR INJUNCTION OR MANDAMUS – FREEDOM OF INFORMATION ACT AND AFFIDAVIT FOR GOOD CAUSE OR PROTECTION OF SOCIAL SECURITY NUMBERS ACT Master 07/09 DC-496 ORDER FOR PETITION FOR INJUNCTION OR WRIT OF MANDAMUS Master 07/09 DC-497 SUBPOENA FOR WITNESS – ATTORNEY ISSUED Master 04/13 (p. 1) 04/13 (p. 2) DC-498 SUBPOENA DUCES TECUM – ATTORNEY ISSUED Master 07/01 (p. 1) 07/04 (p. 2) DC-499 MOTION AND ORDER FOR RELEASE OF VEHICLE Master 07/10 (p. 1) 11/10 (p. 2) COURT CASE FORMS – MENTAL HEALTH (ADULT) Form # Form Name DC-4000 DC-4000S Form Type Revision Date ORDER FOR ALTERNATIVE TRANSPORTATION PROVIDER Master 07/15 DC-4001 PETITION FOR INVOLUNTARY ADMISSION FOR TREATMENT Master DC-4002 ORDER FOR TREATMENT Master DC-4003 ORDER FOR TREATMENT OF INMATE Master DC-4005 PETITION FOR REVIEW OF MANDATORY OUTPATIENT TREATMENT Master DC-4007 ORDER – REVIEW OF MANDATORY OUTPATIENT TREATMENT Master DC-4008 DC-4010 ORDER OF APPOINTMENT OF EXAMINER – EXAMINATION FOR INVOLUNTARY TREATMENT PETITION FOR RESCISSION OF MANDATORY OUTPATIENT TREATMENT 07/15 (p. 1) 07/13 (p. 2) 07/12 (p. 1) 07/12 (p. 2) 07/12 (p. 3) 07/16 (p. 4) 07/17 (p. 1) 07/12 (p. 2) 07/10 (p. 1) 07/10 (p. 2) 07/12 (p. 1) 07/16 (p. 2) Master 07/10 Master 07/10 DC-4012 ORDER – RESCISSION OF MANDATORY OUTPATIENT TREATMENT Master 07/12 (p. 1) 07/12 (p. 2) 07/16 (p. 3) DC-4015 PETITION TO CONTINUE MANDATORY OUTPATIENT TREATMENT Master 07/10 DC-4017 ORDER – CONTINUE MANDATORY OUTPATIENT TREATMENT Master 07/12 (p. 1) 07/12 (p. 2) 07/16 (p. 3) Revised 10/2017 Page 12 of 21 COMMONWEALTH OF VIRGINIA DISTRICT COURT FORMS LISTING COURT CASE FORMS – MENTAL HEALTH (ADULT) Form # DC-4020 DC-4022 DC-4024 DC-4026 DC-4029 DC-4032 Form Name TRACKING DOCUMENT FOR SENDING OR RECEIVING MANDATORY OUTPATIENT TREATMENT ORDER UPON ENTRY TRACKING DOCUMENT FOR SENDING OR RECEIVING MANDATORY OUTPATIENT TREATMENT ORDER UPON TRANSFER ORDER – TRANSFER OF JURISDICTION PURSUANT TO VIRGINIA CODE § 37.2-817 J CAPIAS: TRANSPORT AND MANDATORY EXAMINATION ORDER APPLICATION FOR COPY OF RECORDING OF COMMITMENT HEARING WAIVER OF CONFIDENTIALITY OF COURT RECORDS – COMMITMENT FOR MENTAL HEALTH TREATMENT DC-4000S Form Type Revision Date Master 07/16 Master 07/16 Master 10/14 Master 05/15 Master 07/08 Master 07/08 DC-4035 PETITION AND ORDER FOR ACCESS TO DISPOSITIONAL ORDER Master 07/08 DC-4035(A) ORDER FOR ACCESS TO DISPOSITIONAL ORDER Master 07/08 Master 10/13 Master 07/11 DC-4040 DC-4042 PETITION TO RESTORE RIGHT TO PURCHASE, POSSESS OR TRANSPORT A FIREARM ORDER – RESTORATION OF RIGHT TO PURCHASE, POSSESS OR TRANSPORT A FIREARM DC-4044 NOTICE OF ALTERNATIVE FACILITY OF TEMPORARY DETENTION Master 07/14 DC-4046 ORDER FOR TRANSPORTATION TO ALTERNATIVE FACILITY OF TEMPORARY DETENTION Master 07/14 DC-4050 EXPLANATION OF EMERGENCY CUSTODY PROCEDURE Printed 07/14 COURT CASE FORMS – JUVENILE Form # Form Name DC-501 DC-500S Form Type Revision Date ORDER TO CLOSE HEARING Master 07/96 DC-502A PETITION FOR JUDICIAL AUTHORIZATION OF ABORTION Master 07/12 DC-502B ADVISEMENT OF YOUR RIGHT TO COUNSEL Master 07/12 DC-502C ACKNOWLEDGEMENT OF RIGHT TO COUNSEL AND APPOINTMENT OF COUNSEL Master 07/12 DC-502D ORDER IN PROCEEDING FOR JUDICIAL AUTHORIZATION OF ABORTION Master 07/12 DC-502E NOTICE OF APPEAL – JUDICIAL AUTHORIZATION OF ABORTION Master 07/12 DC-503 PETITION FOR COURT APPROVAL OF STANDBY GUARDIAN Master 10/15 (p. 1) 07/98 (p. 2) DC-504 NOTICE OF PETITION FOR COURT APPROVAL OF STANDBY GUARDIAN Master 10/15 DC-505 ORDER APPROVING STANDBY GUARDIAN Master 10/15 (p. 1) 07/98 (p. 2) Revised 10/2017 Page 13 of 21 COMMONWEALTH OF VIRGINIA DISTRICT COURT FORMS LISTING COURT CASE FORMS – JUVENILE Form # Form Name DC-506 DC-500S Form Type Revision Date NOTICE OF REVOCATION/STATEMENT OF REFUSAL – STANDBY GUARDIAN Master 10/15 DC-507 PETITION FOR ORDER OF EMANCIPATION Master 07/16 DC-508 ACKNOWLEDGEMENT OF NOTICE OF NEXT HEARING DATE Master 11/16 DC-509 AFFIDAVIT/CERTIFICATION OF PARENTAL IDENTITY OR LOCATION Master 10/15 DC-510 SUMMONS Master 07/09 (p. 1) 07/17 (p. 2) DC-510x SUMMONS (continuous paper) Printed 07/09 (front) 07/17 (reverse) DC-511 PETITION Master 11/16 (p. 1) 12/01 (p. 2) DC-512 NOTICE OF HEARING Printed 10/08 DC-513 ADVISEMENT AND REQUEST FOR APPOINTMENT OF COUNSEL Printed 05/07 DC-514 ORDER FOR APPOINTMENT OF GUARDIAN AD LITEM Printed 10/14 (front) 09/03 (reverse) DC-515 WAIVER OF RIGHT TO BE REPRESENTED BY A LAWYER (JUVENILE) Printed 05/07 DC-517 WAIVER OF JURISDICTION Master 10/07 DC-518 TRANSFER/RETENTION ORDER Master 10/15 (p. 1) 07/12 (p. 2) DC-519 NOTICE OF TRANSFER HEARING Master 05/96 (p. 1) 01/81 (p. 2) DC-520 CERTIFICATION OF JUVENILE FELONY CHARGE Master 07/96 DC-522 ORDER FOR EVALUATION TO DETERMINE COMPETENCY TO STAND TRIAL – JUVENILE Master 07/09 (p. 1) 07/99 (p. 2) DC-523 ORDER FOR PROVISION OF RESTORATION SERVICES TO INCOMPETENT JUVENILE Master 07/09 DC-524 NOTICE OF RIGHT TO CONSIDERATION OF DIVERSION Printed 10/11 DC-526 EMERGENCY REMOVAL ORDER Master DC-527 PRELIMINARY CHILD PROTECTIVE ORDER – ABUSE AND NEGLECT Master DC-528 PRELIMINARY REMOVAL ORDER Master Revised 10/2017 07/17 (p. 1) 07/17 (p. 2) 10/15 (p. 3) 11/16 (p. 1) 10/15 (p. 2) 10/15 (p. 3) 10/15 (p. 4) 07/17 (p. 1) 07/17 (p. 2) 10/15 (p. 3) Page 14 of 21 COMMONWEALTH OF VIRGINIA DISTRICT COURT FORMS LISTING COURT CASE FORMS – JUVENILE DC-500S Form # Form Name DC-529 DETENTION ORDER/CAPIAS PURSUANT TO § 16.1-247(K) Master DC-530 SHELTER CARE ORDER Master DC-531 ORDER FOR INVOLUNTARY TERMINATION OF RESIDUAL PARENTAL RIGHTS Master DC-532 CHILD PROTECTIVE ORDER – ABUSE AND NEGLECT Master DC-533 ASSESSMENT/PAYMENT ORDER Master 10/17 DC-534 ORDER FOR VOLUNTARY TERMINATION OF RESIDUAL PARENTAL RIGHTS Master 11/16 (p. 1) 10/15 (p. 2) DC-535 NOTICE OF TERMINATION OF RESIDUAL PARENTAL RIGHTS Master 06/06 DC-536 TRIAL WITHOUT A LAWYER Master 07/02 DC-538 PLACEMENT ORDER Master 05/08 (p. 1) 05/08 (p. 2) DC-539 RELEASE ORDER Master 11/07 DC-542 ORDER FOR INVESTIGATION AND REPORT Master 10/14 DC-543 CONFIDENTIALITY NOTICE Master 10/07 DC-544 ORDER FOR COURT-APPOINTED SPECIAL ADVOCATE (CASA) Master 05/03 DC-545 PRELIMINARY CHILD PROTECTIVE ORDER Master DC-546 CHILD PROTECTIVE ORDER Master DC-547 SUPPLEMENTAL SHEET TO CHILD PROTECTIVE ORDER Master DC-548 CHILD IN NEED OF SUPERVISION ORDER Master DC-549 ORDER OF EMANCIPATION Master DC-550 PETITION REQUESTING AUTHORIZATION FOR MEDICAL TREATMENT OF JUVENILE Master 10/15 (p. 1) 12/99 (p. 2) DC-551 ORDER AUTHORIZING MEDICAL TREATMENT OF JUVENILE Master 07/92 DC-552 FOSTER CARE SERVICE PLAN TRANSMITTAL Master 11/16 (p. 1) 11/16 (p. 2) Revised 10/2017 Form Type Revision Date 07/17 (p. 1) 07/16 (p. 2) 07/96 (p. 1) 07/91 (p. 2) 10/15 (p. 1) 10/15 (p. 2) 11/16 (p. 1) 10/15 (p. 2) 10/15 (p. 3) 10/15 (p. 1) 07/14 (p. 2) 04/13 (p. 3) 10/15 (p. 1) 04/13 (p. 2) 07/13 (p. 1) 07/13 (p. 2) 10/17 (p. 1) 10/17 (p. 2) 10/17 (p. 3) 07/16 (p. 1) 07/16 (p. 2) Page 15 of 21 COMMONWEALTH OF VIRGINIA DISTRICT COURT FORMS LISTING COURT CASE FORMS – JUVENILE Form # Form Name DC-500S Form Type Revision Date 07/17 (p. 1) 10/15 (p. 2) 07/17 (A-C) 07/16 (p. 3) 07/17 (p. 4) 07/16 (p. 5) 07/14 (p. 6) 07/13 (p. 1) 07/17 (p. 2) 11/16 (p. 1) 07/17 (p. 2) 07/17 (p. 3) 07/17 (p. 4) 07/16 (p. 5) 07/09 (p. 1) 07/17 (p. 2) 07/17 (p. 3) 11/16 (p. 1) 10/15 (p. 2) 07/17 (p. 3) 07/17 (p. 4) 07/17 (p. 5) 07/16 (p. 1) 07/02 (p. 2) 07/01 (A) 07/00 (B) 07/00 (C) 07/04 (p. 1) 07/04 (p. 2) DC-553 DISPOSITIONAL ORDER FOR UNDERLYING PETITION; FOSTER CARE PLAN Master DC-554 PETITION FOR FOSTER CARE REVIEW HEARING Master DC-555 FOSTER CARE REVIEW ORDER Master DC-556 PETITION FOR PERMANENCY PLANNING HEARING Master DC-557 PERMANENCY PLANNING ORDER Master DC-558 PERMANENT FOSTER CARE PLACEMENT ORDER Master DC-559 (A-C) SUPPLEMENT TO ORDER TRANSFERRING CUSTODY Master DC-560 PETITION AND ORDER FOR PARENTAL PARTICIPATION Master DC-561 ADJUDICATORY ORDER FOR ABUSE OR NEGLECT CASES Master DC-562 ORDER FOR CUSTODY TRANSFER TO AGENCY Master DC-563 CHILD IN NEED OF SERVICES ORDER Master DC-564 PETITION FOR RESTORATION OF PARENTAL RIGHTS Master 07/13 (p. 1) 07/13 (p. 2) DC-565 NOTICE OF PRESENTATION OF DRIVER’S LICENSE Printed 07/12 DC-566 PARENTAL PLACEMENT ORDER FOR RESTORATION OF PARENTAL RIGHTS Master 10/15 (p. 1) 07/13 (p. 2) DC-567 ORDER FOR RESTORATION OF PARENTAL RIGHTS Master 10/15 (p. 1) 07/13 (p. 2) DC-568 JUVENILE COMMITMENT REVIEW HEARING ORDER Master 11/06 DC-569 ADJUDICATION AND DISPOSITION ORDER – DELINQUENCY Master 10/17 (p. 1) 10/17 (p. 2) 10/17 (p. 3) Revised 10/2017 11/16 (p. 1) 07/16 (p. 2) 07/17 (p. 1) 07/17 (p. 2) 10/15 (p. 3) 10/17 (p. 1) 10/17 (p. 2) Page 16 of 21 COMMONWEALTH OF VIRGINIA DISTRICT COURT FORMS LISTING COURT CASE FORMS – JUVENILE Form # Form Name DC-570 DC-500S Form Type Revision Date ORDER Printed 11/16 DC-571 ASSESSMENT ORDER – JUVENILE BOOT CAMP Master 10/15 DC-572 JUVENILE COMMITMENT ORDER Master 07/15 DC-573 ORDER FOR CUSTODY/PARENTING TIME/VISITATION ORDER GRANTED TO INDIVIDUAL(S) Master 07/17 (p. 1) 07/17 (p. 2) DC-573-S SUPPLEMENT SHEET TO ORDER FOR CUSTODY/VISITATION GRANTED TO INDIVIDUAL(S) Master 06/06 DC-574 INFORMATION CONSIDERED IN CHILD CUSTODY/VISITATION PROCEEDINGS Master 10/12 DC-575 CONFIDENTIAL MATERIALS – JUVENILE CASE APPEAL/TRANSFER TRANSMITTAL Master 07/14 DC-576 DRIVER’S LICENSE DENIAL ORDER (JUVENILE)/DRIVER’S LICENSE SUSPENSION ORDER (UNDERAGE ALCOHOL VIOLATIONS) DC-577 DRIVER’S LICENSE SUSPENSION ORDER AND ENTRY INTO SERVICES PROGRAM (JUVENILE) DC-578 RESTRICTED DRIVER’S LICENSE Printed 10/15 DC-580 NOTICE OF APPEAL Master 11/16 DC-581 NOTICE OF APPEAL – JUVENILE CIVIL APPEALS Master 07/08 DC-582 REQUEST FOR VIRGINIA REGISTRATION OF A CHILD CUSTODY AND/OR VISITATION DETERMINATION FROM ANOTHER STATE Master 09/02 Master 10/12 Master 12/01 DC-583 DC-584 (DC-261 is pages two and three of DC-260, DC-265, DC-279, DC-282, DC-359, DC-576 & DC-577) (DC-261 is pages two and three of DC-260, DC-265, DC-279, DC-282, DC-359, DC-576 & DC-577) NOTICE OF REQUEST FOR VIRGINIA REGISTRATION OF A CHILD CUSTODY AND/OR VISITATION DETERMINATION FROM ANOTHER STATE SUPPLEMENT TO PETITION FOR EXPEDITED ENFORCEMENT UNDER VIRGINIA CODE § 20-146.29 OF THE UCCJEA Printed Printed 07/17 (p. 1, front) 07/10 (p. 1, reverse) 07/17 (p. 2) 07/17 (p. 3) 07/17 (p. 1, front) 07/10 (p. 1, reverse) 07/17 (p. 2) 07/17 (p. 3) DC-585 NOTICE TO RESPONDENT IN ENFORCEMENT PROCEEDINGS UNDER VIRGINIA CODE § 20-146.29 OF THE UCCJEA Master 12/01 DC-586 EX PARTE ORDER TO TAKE PHYSICAL CUSTODY OF A CHILD Master 10/13 DC-587 MOTION AND ORDER FOR EXPUNGEMENT AND DESTRUCTION OF JUVENILE RECORDS Printed 11/07 DC-588 NOTICE OF EXPUNGEMENT RIGHTS Master 07/14 DC-592 EMERGENCY CUSTODY ORDER – JUVENILE Master 07/14 (p. 1) 07/16 (p. 2) Revised 10/2017 Page 17 of 21 COMMONWEALTH OF VIRGINIA DISTRICT COURT FORMS LISTING COURT CASE FORMS – JUVENILE Form # Form Name DC-594 DC-500S Form Type Revision Date TEMPORARY DETENTION ORDER – JUDGE (JUVENILE) Printed 07/10 (front) 07/16 (reverse) DC-595 PETITION FOR APPROVAL OF VOLUNTARY CONTINUING SERVICES AND SUPPORT Master 07/16 DC-596 ORDER APPROVING VOLUNTARY CONTINUING SERVICES AND SUPPORT Master 11/16 DC-597 ORDER FOR INPATIENT TREATMENT – ADMISSION BY PARENTAL CONSENT Master DC-598 ORDER FOR INVOLUNTARY COMMITMENT FOR INPATIENT TREATMENT – JUVENILE Master DC-599 ORDER FOR INVOLUNTARY ADMISSION TO MANDATORY OUTPATIENT TREATMENT – JUVENILE Master 10/15 (p. 1) 07/16 (p. 2) 10/15 (p. 1) 11/10 (p. 2) 07/16 (p. 3) 10/15 (p. 1) 07/10 (p. 2) 07/16 (p. 3) COURT CASE FORMS – MENTAL HEALTH (JUVENILE) DC-5000S Form # Form Name DC-5005 MOTION FOR REVIEW OF ORDER FOR MANDATORY OUTPATIENT TREATMENT Master DC-5007 ORDER – REVIEW OF ORDER FOR MANDATORY OUTPATIENT TREATMENT Master DC-5008 ORDER OF APPOINTMENT OF EVALUATOR – EVALUATION FOR INVOLUNTARY TREATMENT Master DC-5009 NOTICE AND MANDATORY EXAMINATION ORDER Master 07/14 DC-5015 MOTION TO CONTINUE MANDATORY OUTPATIENT TREATMENT ORDER Master 07/09 DC-5017 ORDER – CONTINUE MANDATORY OUTPATIENT TREATMENT ORDER Master 07/09 (p. 1) 11/10 (p. 2) 07/16 (p. 3) Master 10/14 Master 10/14 Master 10/14 DC-5020 DC-5022 DC-5024 Form Type TRACKING DOCUMENT FOR SENDING OR RECEIVING MANDATORY OUTPATIENT TREATMENT ORDER UPON ENTRY TRACKING DOCUMENT FOR SENDING OR RECEIVING MANDATORY OUTPATIENT TREATMENT ORDER UPON TRANSFER ORDER – TRANSFER OF JURISDICTION PURSUANT TO VIRGINIA CODE § 16.1-345.2 G COURT CASE FORMS – DOMESTIC RELATIONS Form # Form Name DC-601 Revision Date 07/09 (p. 1) 07/09 (p. 2) 11/10 (p. 1) 07/09 (p. 2) 07/16 (p. 3) 07/10 (p. 1) 07/16 (p. 2) DC-600S Form Type Revision Date NOTICE – ADMINISTRATIVE SUPPORT DECISION APPEAL Master 10/02 DC-602 NOTICE OF APPEAL – SUPPORT PROCEEDINGS Master 07/16 (p. 1) 07/08 (p. 2) DC-603 NOTICE OF INFORMATION REQUIRED IN CHILD/SPOUSAL SUPPORT PROCEEDINGS Master 10/12 Revised 10/2017 Page 18 of 21 COMMONWEALTH OF VIRGINIA DISTRICT COURT FORMS LISTING COURT CASE FORMS – DOMESTIC RELATIONS Form # Form Name DC-604 DC-600S Form Type Revision Date ORDER OF REFERRAL AND MEDIATOR APPOINTMENT FORM – CUSTODY, VISITATION AND SUPPORT CASES Master 07/16 (p. 1) 07/16 (p. 2) DC-605 ORDER OF REFERRAL TO PARENT EDUCATION SEMINAR Master 10/12 DC-606 FINANCIAL STATEMENT FOR APPLICATION TO PROCEED IN CUSTODY/VISITATION CASE WITHOUT FILING FEES OR FOR ASSESSMENT OF GUARDIAN AD LITEM COSTS Master 07/17 DC-610 PETITION FOR SUPPORT (CIVIL) Master 07/10 (p. 1) 07/15 (p. 2) DC-611 PETITION FOR PROTECTIVE ORDER – FAMILY ABUSE Master 07/14 (p. 1) 04/13 (p. 2) DC-612 DESERTION/NON-SUPPORT PETITION (CRIMINAL) Master 07/97 (p. 1) 07/15 (p. 2) DC-614 AFFIDAVIT – DESERTION AND NON-SUPPORT Master 04/80 DC-615 RESPONDENT’S REQUEST FOR INCOME DEDUCTION ORDER Master 07/98 DC-616 ORDER OF TRANSFER Master 10/15 DC-617 MOTION AND NOTICE OF PROPOSED INCOME DEDUCTION ORDER FOR SUPPORT Master 12/98 (p. 1) 04/06 (p. 2) DC-618 REQUEST FOR CONFIDENTIALITY – CIVIL Master 07/05 DC-619 EXEMPLIFICATION OF RECORD Master 11/06 DC-620 AFFIDAVIT (UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT) Printed 05/08 (front) 11/96 (reverse) DC-621 NON-DISCLOSURE ADDENDUM Printed 07/09 DC-622 SEALED DOCUMENTS Envelope 05/05 DC-623 MOTION FOR GENETIC TESTING Master 12/01 (p. 1) 12/01 (p. 2) DC-624 PARENTAGE TEST ORDER Printed 12/01 DC-625 MOTION AND NOTICE AND JUDGMENT FOR ARREARAGES Master DC-626 EMERGENCY PROTECTIVE ORDER – FAMILY ABUSE Printed DC-627 PRELIMINARY PROTECTIVE ORDER – FAMILY ABUSE Master DC-628 ORDER OF SUPPORT (CIVIL) Printed Revised 10/2017 07/05 (p. 1) 06/06 (p. 2) 07/16 (p. 1, front) 07/16 (p. 1 & 4, reverse) 07/16 (p. 2 & 3, reverse) 10/11 (p. 1) 07/14 (p. 2) 04/13 (p. 3) 07/15 (p. 1) 07/16 (p. 2) 07/14 (p. 3) Page 19 of 21 COMMONWEALTH OF VIRGINIA DISTRICT COURT FORMS LISTING COURT CASE FORMS – DOMESTIC RELATIONS Form # Form Name DC-629 DC-600S Form Type Revision Date ORDER OF SUPPORT (CRIMINAL) Master 07/15 (p. 1) 07/15 (p. 2) 07/10 (p. 3) DC-630 MOTION TO AMEND OR REVIEW ORDER Printed 05/05 (front) 10/13 (reverse) DC-631 MEDIATION SUPPORT AGREEMENT Master 07/15 (p. 1) 07/16 (p. 2) 10/13 (p. 3) DC-632 ORDER OF SUPPORT (CIVIL) FOR MEDIATION SUPPORT AGREEMENT Master 10/12 DC-633 NOTICE OF ISSUANCE OF EMERGENCY PROTECTIVE ORDER – FAMILY ABUSE Printed 11/16 (p. 1, front) 11/16 (p. 1&4, reverse) 11/16 (p. 2&3, reverse) DC-634 MOTION TO WITHDRAW CONSENT TO DEFERRAL OF PROCEEDINGS PURSUANT TO VA. CODE § 18.2-57.3(B) Master 10/17 DC-635 MOTION FOR SHOW CAUSE SUMMONS OR CAPIAS Printed 10/15 DC-637 CHILD SUPPORT GUIDELINES WORKSHEET Master 10/15 (p. 1) 07/15 (p. 2) DC-638 CHILD SUPPORT GUIDELINES WORKSHEET SPLIT CUSTODY Master 10/15 (p. 1) 07/15 (p. 2) DC-639 CHILD SUPPORT GUIDELINES EXCEPTION SUPPLEMENT TO ORDER FOR SUPPORT Master 07/13 DC-640 CHILD SUPPORT GUIDELINES WORKSHEET – SHARED CUSTODY Master 10/15 (p. 1) 07/17 (p. 2) DC-641 PARENTAGE SUPPLEMENT TO PETITION Master 10/17 DC-644 ORDER DETERMINING PARENTAGE Printed DC-645 INCOME WITHHOLDING FOR SUPPORT Master DC-650 PROTECTIVE ORDER – FAMILY ABUSE Master DC-652 ORDER DISSOLVING PROTECTIVE ORDER Master DC-653 SUPPLEMENTAL SHEET TO PROTECTIVE ORDER Master 10/08 DC-660 PERFORMANCE BOND Master 09/02 DC-670 PETITION FOR SUSPENSION OF PROFESSIONAL OR OTHER LICENSE Master 07/16 Revised 10/2017 10/11 (front) 02/04 (reverse) 10/14 (p. 1) 10/14 (p. 2) 10/14 (p. 3) 10/14 (p. 4) 10/14 (p. 5) 10/14 (p. 6) 10/14 (p. 7) 07/16 (p. 1) 07/16 (p. 2) 07/14 (p. 3) 11/10 (p. 4) 10/15 (p. 1) 10/11 (p. 2) Page 20 of 21 COMMONWEALTH OF VIRGINIA DISTRICT COURT FORMS LISTING COURT CASE FORMS – DOMESTIC RELATIONS Form # Form Name DC-671 DC-600S Form Type Revision Date ORDER FOR SUSPENSION OF PROFESSIONAL OR OTHER LICENSE Master 10/02 DC-672 CERTIFICATE OF COMPLIANCE FOR REINSTATEMENT OF PROFESSIONAL OR OTHER LICENSE Master 10/02 DC-680 CONSENT FOR ADOPTION Master 07/08 DC-684 FILING OF FOREIGN PROTECTIVE ORDER Master 10/15 DC-685 REQUEST FOR VIRGINIA REGISTRATION OF NON-VIRGINIA SUPPORT ORDER Master 04/15 (p. 1) 04/15 (p. 2) DC-686 NOTICE OF REGISTRATION OF NON-VIRGINIA SUPPORT ORDER Master 04/15 (p. 1) 04/15 (p. 2) COURT CASE FORMS – MAGISTRATE Form # Form Name DC-801 DC-800S Form Type Revision Date ZONING ORDINANCE INSPECTION AFFIDAVIT AND WARRANT Master 07/17 (p. 1) 07/14 (p. 2) DC-890 MAGISTRATE LOG Printed 09/92 DC-892 MAGISTRATE MONTHLY SUMMARY REPORT Printed 05/00 DC-894 TRANSMITTAL SETTLEMENT CARDS Printed 07/88 DC-894(A) TEMPORARY DETENTION ORDER – MAGISTRATE Master DC-895 TEMPORARY DETENTION ORDER – MAGISTRATE (JUVENILE) Master 07/16 (p. 1) 07/16 (p. 2) 07/10 (p. 1) 07/16 (p. 2) CIRCUIT COURT FORMS USED IN DISTRICT COURT Form # Form Name Form Type Revision Date CC-1390 ORDER FOR DNA OR HIV TESTING AND/OR FOR PREPARATION OF REPORTS TO CENTRAL CRIMINAL RECORDS EXCHANGE Printed 07/07 CC-1414 PETITION FOR PROCEEDING IN CIVIL CASE WITHOUT PAYMENT OF FEES OR COSTS Master 10/14 CC-1433 NOTICE OF COMMENCEMENT OF ACTION AND REQUEST FOR WAIVER OF SERVICE OF PROCESS Master 07/11 Revised 10/2017 Page 21 of 21
Source Exif Data:
File Type : PDF File Type Extension : pdf MIME Type : application/pdf PDF Version : 1.5 Linearized : No Page Count : 21 Language : en-US Tagged PDF : Yes Title : FOR REFERENCE ONLY: This is a list of all the District Court Forms produced by the Office of the Executive Secretary includin Author : K.Perkins Creator : Microsoft® Word 2016 Create Date : 2018:01:23 11:14:58-05:00 Modify Date : 2018:01:23 11:14:58-05:00 Producer : Microsoft® Word 2016EXIF Metadata provided by EXIF.tools