Form DC-481 SHOW CAUSE SUMMONS (CIVIL) Page: 2
DISTRICT COURT MANUAL FORMS VOLUME
SHOW CAUSE SUMMONS (CIVIL) VA. CODE §§ 8.01-508, 8.01-519, 8.01-564,
CASE NO.
SUMMON THIS RESPONDENT:
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LAST NAME, FIRST NAME, MIDDLE NAME
...........................................................................................................
...........................................................................................................
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SHOW CAUSE SUMMONS
(CIVIL)
In connection with the case of
[ ] Commonwealth of Virginia
[ ] ....................................................................................................
.............................................................................................................
v./In re
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COMPLETE DATA BELOW IF KNOWN
BORN HT
RACE SEX
MO DAY YR FT IN
WGT EYES HAIR
SSN
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.............................................................................................................
.............................................................................................................
UNDERLYING CASE NO.
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........................................................
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HEARING
DATE AND
TIME
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Commonwealth of Virginia 8.01-565, 16.1-69.24, 19.2-358
[ ] General District Court
............................................................................................................. [ ] Juvenile and Domestic Relations District Court
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CITY OR COUNTY
.......................................................................................................................................................................................................................
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STREET ADDRESS OF COURT
TO ANY AUTHORIZED OFFICER:
You are hereby commanded to summons forthwith the Respondent to appear before this Court on
DECEMBER 2007
........................................................................ to show cause, if any, why Respondent should not, pursuant to
DATE AND TIME
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Virginia Code § ...........................................................................
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[ ] have judgment in the amount of $ ......................................................... or other such amount as may be proved
entered against the Respondent Garnishee.
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[ ]
be imprisoned until the Respondent complies with the Court’s order or be fined for:
[ ] failure to pay fines, costs, forfeiture, restitution and/or penalty or an installment there thereof:
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payment due: $ ................................................................... on .........................................................................................
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[ ] failure to provide support as ordered on ...................................................................................................................
DATE
$ .................................................................... per ...................................................................................................................
with $ ......................................................... arrearage as of ...........................................................................................
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[ ] failure to obey and order of [ ] this court [ ] .....................................................................................................
dated ......................................... ordering ..........................................................................................................................
[ ] failure to appear on .................................................................... to answer interrogatories
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DATE
[ ] (Other-Explain) ...................................................................................................................................................................
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....................................................................................................................................................................................................
....................................................................................................................................................................................................
[ ] CONTINUED ON REVERSE
WARNING: Failure to appear may result in your being fined or jailed.
............................................................... _________________________________________________________________
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DATED ISSUED [ ] CLERK [ ] MAGISTRATE [ ] JUDGE
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FORM DC-481 (FRONT) 10/06
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Form DC-481 SHOW CAUSE SUMMONS (CIVIL) Page: 3
DISTRICT COURT MANUAL FORMS VOLUME
DECEMBER 2007
Data Elements, front
1. Court name. Check box for type of court.
2. Address of court.
3. Hearing date and time.
4. Applicable code section.
5. Judgment amount requested.
6. Check if imprisonment is requested.
7. Check if requesting imprisonment for failure to make payment.
8. Check if requesting imprisonment for failure to provide support.
9. Check if requesting imprisonment for failure to obey a court order. Check box to indicate
which court issued the order.
10. Check if requesting imprisonment for failure to appear to answer interrogatories.
11. Check if there is another reason for requesting the Show Cause Summons. Explain the
reason, using reverse of form if more space is necessary.
12. Date issued.
13. Signature and title of issuer.
14. Court case number.
15. Name of respondent.
16. Fill in physical characteristics of respondent, if known.
17. Social security number of respondent.
18. Check box if suit is brought by Commonwealth. If not, check other box and fill in name of
plaintiff in connected case.
19. Fill in name of defendant in connected case, or if style of case is “In re,” fill in case name.
20. Companion case number. See data elements 5-9.
21. Hearing date and time. Additional space is allotted to allow for inclusion of subsequent
hearings.
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Form DC-481 SHOW CAUSE SUMMONS (CIVIL) Page: 4
DISTRICT COURT MANUAL FORMS VOLUME
[ ] Dismissed on motion of Petitioner.
1
The Respondent was this day:
[ ] tried in absence
DECEMBER 2007
[ ] present
The Respondent was:
[ ] represented by counsel
.......................................................................
NAME OF COUNSEL
[ ] not represented by counsel
The Respondent:
[ ] denied contempt
[ ] did not contest contempt
[ ] admitted contempt
And was TRIED and FOUND by me:
[ ] not guilty of civil contempt
[ ] guilty of civil contempt
[ ] See attached Order
In addition:
[ ] that there is a support arrearage of $ .......................
as of .....................................
[ ] with interest included
[ ] without interest included
[ ] that the garnishee should have withheld $ ................
[ ] Pending disposition on ..............................................,
DATE AND TIME
the court ORDERS
.............................................................................
.............................................................................
[ ] I ORDER the charge dismissed
[ ] with prejudice
[ ] without prejudice
......................................
DATE
FORM DC-481 (REVERSE) 5/07
I impose the following Disposition:
[ ] Placed in custody until the respondent complies
with the requirements of the court’s order for a
maximum of
...............................................................
[ ] Civil fine of $ ...........................................
payable to ................................................
[ ] Judgment against garnishee in favor of judgment
creditor of $
.............................................
[ ] Other: .....................................................
...............................................................
...............................................................
[ ] Appeal Bond $ .........................................
[ ] Appearance Bond $ ...................................
[ ] unsecured [ ] secured
[ ] Accrual Bond $ ........................................
[ ] Work Release [ ] authorized if eligible
[ ] required [ ] not authorized
[ ] Other: ......................................................
...............................................................
[ ] Respondent may purge his/her jail sentence by
paying a lump sum of $
............................ to
[ ] DCSE [ ] ........................................
[ ] Purge Clause ............................................
...............................................................
...............................................................
[ ] Respondent has been advised of his or her
right to appeal the civil contempt.
_____________________________________
JUDGE
RETURNS: Each respondent was served according
to law, as indicated below, unless not found.
Name
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . .
[ ] PERSONAL SERVICE
Telephone
No. . . . . . . . . . . . . . . . . . . . . . . .
[ ] Being unable to make personal service, a copy was
delivered in the following manner:
[ ] Delivered to family member (not temporary sojourner
or guest) age 16 or older at usual place of abode of
party named above after giving information of its
purport. List name, age of recipient, and relation of
recipient to party named above.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
[ ] Posted on front door or such other door as appears to
be the main entrance of usual place of abode, address
listed above. (Other authorized recipient not found.)
[ ] Served on Secretary of the Commonwealth.
[ ] Not found
SERVING OFFICER
. . . . . . . . . . . . . for ___________________________
DATE
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2
25
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3
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26
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1
5
2716
5
28
17
6
18
19
7
8
9
20 29
30
3
1
21
32
33
10
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23 24
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Form DC-481 SHOW CAUSE SUMMONS (CIVIL) Page: 5
Data Elements, reverse
1. Check box if case is dismissed on motion of the
requesting party.
2.
Check applicable box if respondent was present.
3.
Check applicable box to indicate if respondent
was represented by counsel. If so, enter the name
of the counsel.
4.
Check box that corresponds to answer of
respondent.
5.
Check box that corresponds to finding of the
court.
6.
Check box if court finds there is a support
arrearage. Enter the amount of the arrearage and
effective date.
7.
Check box that corresponds to whether arrearage
includes interest.
8.
Check box if court finds that garnishee should
have withheld a sum. Enter the amount that the
garnishee should have withheld.
9.
Check box if case is continued. Enter interim
orders below.
10.
Check if the charge is dismissed with box
indicating whether charge is dismissed with or
without prejudice.
11.
Check if respondent is to be incarcerated until
there is compliance with the order and enter the
maximum time period of incarceration.
12.
Check if civil fine imposed and enter the amount
of the fine and to whom it should be paid.
13.
Check if the court finds in favor of the judgment
creditor against the garnishee and enter the
amount to be paid by the garnishee to the
judgment creditor.
14.
Check box and enter any other disposition.
15.
Check box if appeal bond is required and insert
amount of the bond.
16.
Check box if appearance bond is required, insert
the amount of bond and check box indicating
whether bond is secured or unsecured.
17. Check box if accrual bond is required and insert
amount of bond.
18.
Check box for work release and indicate by
checking box whether work release is authorized,
required or not authorized.
19.
Check box and enter any other disposition.
20.
Check box for lump sum payment purge
provision, enter lump sum amount required to
purge contempt and identify DCSE or another
payee.
21.
Check box and enter any purge provision not
indicated in Data Element 20.
22.
Check box if respondent notified of right to
appeal finding of civil contempt.
23.
Date of entry of order.
24.
Signature of judge.
25.
Name and address (and telephone number if
known) of party to be served (to be inserted by
clerk or judge).
26.
Serving officer to check this box if personal
service obtained.
27.
Serving officer to check the appropriate box to
designate type of substitute service.
28.
If served by leaving a copy with a family member
age 16 or older, check appropriate box and insert
required information.
29.
If served on the Secretary of the Commonwealth,
check this box.
30.
Serving officer to check this box if unable to
serve process.
31.
Signature of serving officer.
32.
Date of signature.
DISTRICT COURT MANUAL FORMS VOLUME
DECEMBER 2007
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Form DC-481 SHOW CAUSE SUMMONS (CIVIL)
33.
Name of sheriff if served by deputy sheriff.
DISTRICT COURT MANUAL
