FORM DC-431 (MASTER, PAGE ONE OF TWO) 10/19
TENANT’S PETITION FOR RELIEF FROM UNLAWFUL EXCLUSION
Commonwealth of Virginia VA. CODE § 55.1-1243
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General District Court
CITY OR COUNTY
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STREET ADDRESS OF COURT
TO ANY AUTHORIZED OFFICER: You are hereby commanded to summon the Defendant(s).
TO THE DEFENDANT(S): You are summoned to appear before this Court at the above address
on .................................................................................................... to answer the Plaintiff(s)’ civil claim (see below).
RETURN DATE AND TIME
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DATE ISSUED [ ] CLERK [ ] DEPUTY CLERK [ ] MAGISTRATE
CLAIM: I, the undersigned Plaintiff-Tenant, this day assert that Plaintiff(s)-Tenant(s) entered into a
rental agreement as indicated with Defendant(s)-Landlord(s) for the rental of the premises indicated.
I further assert that
[ ]
the Defendant(s) unlawfully removed or excluded the Plaintiff(s) from the premises,
specifically, .................................................................................................................................................................
[ ] the Defendant(s) willfully diminished services to the Plaintiff(s) by interrupting or causing the
interruption of an essential service to the Plaintiff(s),
specifically, .................................................................................................................................................................
Plaintiff(s) therefore requests that the court grant the following relief:
[ ] allow the Plaintiff(s) to recover possession of the premises;
[ ] require the Defendant(s) to resume any interrupted essential service; or
[ ] terminate the rental agreement,
and
[ ] recover actual damages of
................................................. ,
[ ] reasonable attorney fees.
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DATE [ ] PLAINTIFF-TENANT [ ] PLAINTIFF-TENANT’S ATTORNEY
CASE DISPOSITION Defendant(s) Present? [ ] YES [ ] NO
[ ] JUDGMENT for Plaintiff(s)
[ ] Recovery of possession of premises.
[ ] Defendant(s) is required to resume the following interrupted essential service:
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[ ] Rental agreement is terminated, and the Defendant(s) is ordered to return any security deposit
in accordance with § 55.1-1226.
[ ] Actual damages in the amount of
............................................. ,
[ ] Reasonable attorney fees of ..............................................
[ ] JUDGMENT for [ ] named Defendant(s)-Landlord(s) [ ]
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[ ] NON-SUIT [ ] DISMISSED
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DATE JUDGE
HEARING DATE
AND TIME
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JUDGMENT PAID OR
SATISFIED
PURSUANT TO
ATTACHED NOTICE
OF
SATISFACTION.
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DATE
________________________
CLERK
DISABILITY
ACCOMMODATIONS
for loss of hearing,
vision, mobility, etc.,
contact the court ahead of
time.
CASE NO.
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PLAINTIFF(S) (LAST NAME, FIRST NAME MIDDLE INITIAL)
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V.
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DEFENDANT(S) (LAST NAME, FIRST NAME, MIDDLE INITIAL)
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TENANT’S PETITION FOR RELIEF
FROM UNLAWFUL EXCLUSION
TO DEFENDANT: You are not required to appear;
however, if you fail to appear, judgment may be
entered against you. See the additional notice on the
reverse about requesting a change of trial location.
[ ] To dispute this claim, you must appear on the
return date to try this case.
[ ] To dispute this claim, you must appear on the
return date for the judge to set another date for
trial.
Bill of Particulars
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ORDERED DUE
Grounds of Defense ................................. ......................
ORDERED DUE
ATTORNEY FOR PLAINTIFF(S)
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ATTORNEY FOR DEFENDANT(S)
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DATE RENTAL AGREEMENT ENTERED INTO DATE RENTAL PERIOD COMMENCED DATE RENTAL PERIOD ENDS
ADDRESS/LOCATION OF PREMISES