General Civil Case Cover Sheet - Preparation Worksheet - Virginia

VIRGINIA CIRCUIT COURT CIVIL COVER SHEET PREPARATION WORKSHEET

NOT FORM CC-1416

Do not file this worksheet. Transfer the approved information to the current
official Cover Sheet for Filing Civil Actions, Form CC-1416.

• Current Form CC-1416
• Official CC-1416 Instructions
• Circuit Court Civil Filing Fee Calculation

The cover sheet accompanies the filed circuit-court document; it is not the
complaint, petition, summons, service request, jury demand, fee calculation, or
legal certification.

1. Form and Filing Control

The clerk enters the case number. Do not invent or reuse one for a new action.

2. Court and Caption

• Circuit Court: [NAME] Circuit Court
• Case number: [CLERK USE / EXISTING NUMBER FOR SUBSEQUENT ACTION]
• Plaintiff or “In re” name: [EXACT CAPTION]
• Additional plaintiff line: [NAME / NONE]
• Defendant name: [EXACT CAPTION / NONE]
• Additional defendant line: [NAME / NONE]

Compare the cover sheet character for character with the filed document.

3. Filer Role — Data Element 5

Person signing is:

• ☐ Plaintiff
• ☐ Defendant
• ☐ Attorney for Plaintiff
• ☐ Attorney for Defendant

Do not add a role that the current form does not offer. If the filing posture
does not fit, obtain clerk or counsel instructions.

4. Action-Type Selection — Data Element 6

Select the one box that most closely identifies the claim asserted or
relief sought. Use the wording printed on the current form, not a numeric code
from page two.

General Civil — Subsequent Actions

• ☐ Claim Impleading Third Party Defendant — Monetary Damages
• ☐ Claim Impleading Third Party Defendant — No Monetary Damages
• ☐ Counterclaim — Monetary Damages
• ☐ Counterclaim — No Monetary Damages
• ☐ Cross Claim
• ☐ Interpleader
• ☐ Reinstatement other than divorce or driving privileges
• ☐ Removal of Case to Federal Court

General Civil — Business and Contract

• ☐ Attachment
• ☐ Confessed Judgment
• ☐ Contract Action
• ☐ Contract Specific Performance
• ☐ Detinue
• ☐ Garnishment

General Civil — 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

General Civil — 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 — ABC Board
• ☐ Appeal/Judicial Review — Board of Zoning
• ☐ Appeal/Judicial Review — Compensation Board
• ☐ Appeal/Judicial Review — DMV License Suspension
• ☐ Appeal/Judicial Review — Employee Grievance Decision
• ☐ Appeal/Judicial Review — Employment Commission
• ☐ Appeal/Judicial Review — Local Government
• ☐ Appeal/Judicial Review — Marine Resources Commission
• ☐ Appeal/Judicial Review — School Board
• ☐ Appeal/Judicial Review — Voter Registration
• ☐ Other Administrative Appeal

Domestic / Family

• ☐ Adoption
• ☐ Adoption — Foreign
• ☐ Adult Protection
• ☐ Annulment
• ☐ Annulment — Counterclaim/Responsive Pleading
• ☐ Child Abuse and Neglect — Unfounded Complaint
• ☐ Civil Contempt
• ☐ Divorce — Complaint Contested
• ☐ Divorce — Complaint Uncontested
• ☐ Divorce — Counterclaim/Responsive Pleading
• ☐ Reinstatement — Custody/Visitation/Support/Equitable Distribution
• ☐ Separate Maintenance
• ☐ Separate Maintenance Counterclaim/Responsive Pleading

Writs

• ☐ Certiorari
• ☐ Habeas Corpus
• ☐ Mandamus
• ☐ Prohibition
• ☐ Quo Warranto

Probate / Wills / Trusts

• ☐ Accounting
• ☐ Aid and Guidance
• ☐ Appointment — Guardian/Conservator
• ☐ Appointment — Standby Guardian/Conservator
• ☐ Appointment — Custodian/Successor Custodian (UTMA)
• ☐ Trust — Impress/Declare/Create
• ☐ Trust — Reformation
• ☐ Will — Construe
• ☐ Will — Contested

Miscellaneous

Use the exact current-form list. Common selections include:

• ☐ Amend Birth/Death Certificate
• ☐ Appointment — Church Trustee / Conservator of Peace / Marriage Celebrant
• ☐ Approval of Transfer of Structured Settlement
• ☐ Bond Forfeiture Appeal
• ☐ Declaratory Judgment
• ☐ Declare Death
• ☐ Driving Privileges
• ☐ Expungement
• ☐ Firearms Rights — Restoration
• ☐ Forfeiture of Property or Money
• ☐ Freedom of Information
• ☐ Injunction
• ☐ Interdiction
• ☐ Interrogatory
• ☐ Judgment Lien — Bill to Enforce
• ☐ Law Enforcement/Public Official Petition
• ☐ Name Change
• ☐ Referendum Elections
• ☐ Sever Order
• ☐ Taxes
• ☐ Vehicle Confiscation
• ☐ Voting Rights — Restoration
• ☐ Other: [EXACT DESCRIPTION]

If no printed selection applies, the official instructions direct use of
“Other” under Miscellaneous with the action identified.

5. Selection Review

• Primary claim or requested relief in filed document: [DETAILS]
• Selected CC-1416 label: [EXACT LABEL]
• Other claims or remedies considered: [DETAILS]
• Why selected label is closest: [DETAILS]
• Clerk or counsel consulted, if ambiguous: [NAME / DATE / INSTRUCTION]

Do not enter the four-letter clerk code printed on page two. Page two is for
the clerk's office and does not require filer completion.

6. Damages — Data Element 7

• ☐ Monetary damages are claimed.
• ☐ No monetary damages are claimed.

If claimed, amount to enter: $[AMOUNT]

Source in filed complaint, counterclaim, or petition: [PAGE / PARAGRAPH]

Calculation record: [FILE / EXPLANATION]

Do not split compensatory, punitive, interest, fees, and costs into invented
cover-sheet fields. The current form supplies one damages amount line. Counsel
must decide what amount belongs there based on the filed document and current
procedure.

7. Signatory Information — Data Elements 8-12

• Date: [DATE]
• Signature: [SIGN ON OFFICIAL FORM]
• Signatory role: [SELECTED ROLE]
• Printed name: [NAME]
• Address: [ADDRESS]
• Telephone number: [PHONE]
• Email address, optional: [EMAIL / OMIT]

Authority to sign for a party: [DETAILS]

8. Separate Filing-Packet Controls

These are not CC-1416 fields. Track them separately so they are not written
onto the official cover sheet.

The official fee calculator—not this cover sheet—collects court selection,
case type, lawsuit amount, sheriff-service choice, and number to be served for
fee calculation.

9. Final Comparison

• Current official CC-1416 downloaded: ☐ Yes ☐ No
• Page one only completed by filer: ☐ Yes ☐ No
• Circuit court and caption match filed document: ☐ Yes ☐ No
• Correct filer role selected: ☐ Yes ☐ No
• One closest action type selected: ☐ Yes ☐ No
• “Other” used only when no printed type applies: ☐ Yes ☐ No
• Damages box and amount match filed document: ☐ Yes ☐ No
• Date, signature, printed name, address, and telephone complete: ☐ Yes ☐ No
• Optional email decision made: ☐ Yes ☐ No

• No invented jury, ADR, service, fee, military, or certification fields added:
  ☐ Yes ☐ No

• Separate filing packet reviewed: ☐ Yes ☐ No

Reviewer: [NAME / ROLE]

Date: [DATE]

Notes: [DETAILS]

Official Sources

• Virginia Form CC-1416
• Virginia Instructions for Form CC-1416
• Virginia Circuit Court Civil Filing Fee Calculation