COMMONWEALTH OF VIRGINIA
IN THE CIRCUIT COURT OF ___________________ COUNTY
(Pursuant to Section 8.01-446.1 of the Code of Virginia of 1950, as amended.)
TYPE OF FILING: {check one} ORIGINAL BOOK #___________ PAGE ________
( ) Assignment
( ) Release ORIGINAL DATE DOCKETED _______________
( ) Partial Release
( ) Credit(s)
( ) Additional Debtor(s)
( ) New Name of Debtor
Date of Judgment: ____________________ Amount of Judgment: $__________________
Plaintiff(s): _______________________________________________________________________
Defendant(s): ______________________________________________________________________
Property to be Released (if Partial Release): ____________________________________________________________________________
Given under my hand this ________ day of ___________________________, ________.
___________________________________
(Plaintiff) (Attorney for Plaintiff)
(Authorized Agent for Plaintiff)
STATE OF VIRGINIA,
COUNTY/CITY OF ____________________; To-Wit:
The foregoing instrument was acknowledged before me this ______ day of ____________________, _______, by _______________________________________.
_________________________________
Notary Public
My Commission Expires: _______________________
Any judgment creditor who knowingly gives false information upon such certificate made under this Section shall be guilty of a Class 1 Misdemeanor.
DATE RELEASED BY COURT AUTHORITY: _________________________
INITIALS OF RELEASER: ________________
No guidelines are available for this form at this time.