Ready to Edit

Civil Cover Sheet (VA CC-1416 Intake Worksheet) - Free Editor

CIVIL COVER SHEET

(Virginia Circuit Court — CC-1416 Intake Worksheet)

[// GUIDANCE: Use as a worksheet; enter responses into the clerk’s CC-1416 form. Confirm any local supplements (e.g., Fairfax, Norfolk) before filing.]

1. COURT & CAPTION

text
VIRGINIA: IN THE CIRCUIT COURT OF [COUNTY/CITY]

[PLAINTIFF NAME], Plaintiff,
v. Case No.: [TBD BY CLERK]
[DEFENDANT NAME], Defendant.

2. FILER IDENTITY (MATCH CC-1416)

☐ Plaintiff - ☐ Defendant
☐ Attorney for Plaintiff - ☐ Attorney for Defendant
☐ Other: [DESCRIBE]

3. PARTIES (INTAKE)

Plaintiff(s): [LIST NAMES / ADDRESSES]
Defendant(s): [LIST NAMES / ADDRESSES]
Add separate sheet if more parties.

4. ATTORNEY / CONTACT

Attorney Name / VSB No.: [NAME], VSB [NUMBER]
Firm: [LAW FIRM NAME]
Address: [STREET, CITY, STATE ZIP]
Phone/Email: [PHONE] | [EMAIL]
☐ Self-represented (no attorney)

5. CASE CATEGORY (USE CC-1416 OPTIONS)

[// GUIDANCE: Select the CC-1416 category; examples below mirror the form but are not exhaustive. Use the exact language/codes on CC-1416.]
- GENERAL CIVIL — Business & Contract: ☐ Debt/Confession of Judgment ☐ Contract Action/Other ☐ Detinue
- GENERAL CIVIL — Property: ☐ Unlawful Detainer ☐ Ejectment ☐ Landlord/Tenant ☐ Eminent Domain/Condemnation ☐ Partition ☐ Annexation ☐ Quiet Title/Other Property
- GENERAL CIVIL — Tort: ☐ Motor Vehicle PI/PD ☐ Wrongful Death ☐ Medical Malpractice ☐ Products Liability ☐ Other Tort
- ADMINISTRATIVE LAW: [___] Administrative Appeal
- DOMESTIC/FAMILY: ☐ Divorce/Annulment ☐ Separate Maintenance ☐ Support ☐ Adoption/Surrogacy ☐ Other Domestic (per CC-1416)
- PROBATE / WILLS & TRUSTS: ☐ Wills & Estates ☐ Fiduciary/Trusts ☐ Other Probate
- MISCELLANEOUS: ☐ Interpleader ☐ Declaratory/Injunctive Relief ☐ Other (specify): __________
[// GUIDANCE: Use the exact CC-1416 language/codes in your filing.]

5A. SUBSEQUENT ACTIONS (MATCH CC-1416)

☐ Claim Impleading Third-Party Defendant — Monetary
☐ Claim Impleading Third-Party Defendant — No Monetary
☐ Counterclaim — Monetary
☐ Counterclaim — No Monetary
☐ Cross-Claim
☐ Interpleader
☐ Reinstatement (Former Case No.: __________)
☐ Removal to Federal Court

6. DAMAGES (CC-1416 FIELD)

Damages in the amount of $[AMOUNT] are claimed.
☐ Injunctive / declaratory relief requested: [DETAILS]

7. JURY DEMAND (INTAKE)

☐ Jury requested
☐ Non-jury

8. SERVICE & SPECIAL NOTICES (INTAKE)

Service addresses for each defendant: [LIST]
Method requested: ☐ Sheriff ☐ Private process server ☐ Secretary of the Commonwealth ☐ DMV (long-arm)
Interpreter or accommodation needed: [YES/NO — LANGUAGE/ACCOMMODATION]

9. RELATED CASES (INTAKE)

Related case numbers / courts (if any): [LIST OR "NONE"]
Consolidation requested: [YES/NO — EXPLAIN]

10. SIGNATURE (TRANSFER TO CC-1416)

text
Date: [DATE]

____________________________________
[ATTORNEY NAME], VSB [NUMBER] / Pro Se
Attorney for [PLAINTIFF/DEFENDANT]
[// GUIDANCE: Use the official CC-1416 for filing. Check current filing fees, sheriff service fees, and local e-filing rules. Some circuits (e.g., Fairfax) require additional coversheets.]

AI Legal Assistant