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VIRGINIA CIVIL RIGHTS
RESTORATION GUIDE
Fall 2011
Virginia is one of only four states in the country whose laws forever strip individuals civil rights upon a
felony conviction, including their right to vote, unless individually restored by the Governor. To date,
hundreds of thousands of Virginians had been stripped of their rights to vote, run for public office, serve on a
jury, and serve as a public notary.
This restoration guide contains step-by-step instructions on how to determine eligibility and how to apply
directly to the Governor for restoration or petition the court for initial review. It also contains application
forms, criminal code reference tables, public notary information, and instructions on how to obtain or correct
identification.
In Virginia, any person convicted of a felony is stripped of certain civil rights forever. New Virginia residents who
have not restored their civil rights in the state of their conviction(s) also are stripped of their rights. These rights,
however, can be restored through an appeal to the Governor of Virginia. This guide explains the process for restoring
your civil rights, including your right-to-vote. There are three different methods to do this depending on your
circumstances:
A)
Short application for non-violent offenses;
B)
Long application for violent, drug, election law and all other offenses, and
C)
Petition to the court for non-violent offenses.
Part 1: Frequently Asked Questions about VAs Rights Restoration Process

1. How do I know whether my civil rights have been taken away?
If you are convicted of a felony offense your civil rights have been taken away, including your right to vote, right to run
for public office, right to serve on a jury, and right to serve as a notary public, in Virginia. A felony conviction can come
from a guilty plea to a felony charge or trial conviction by a judge or jury.
It is important to know that your right to vote was stripped away if you are a Virginia resident OR if you were convicted
by a Virginia court. This is even true if you have a federal felony conviction or a felony conviction from another state
and you have not had your rights restored from the state of your conviction.
2. If my civil rights were taken, can I immediately apply to restore my rights?
Unfortunately you cannot. First, you cannot restore your rights if you are incarcerated, on probation, parole, or still have
outstanding court-imposed fines or fees. You must have completed your full sentence. Second, you must become
eligible.
You become eligible when, if you were convicted of a non-violent felony offense, you wait two years without any
other convictions (felony or misdemeanor) from the end of your sentence. If you were convicted of a violent or
election-related offense, you must wait five years without any other convictions. Also, you may not be eligible if you
have certain criminal convictions or pending cases. If you have completed the waiting period, and have no disqualifying
criminal convictions or charges, only then can you apply to the Governor to restore your rights.
If you have a suspended sentence you should be able to apply for restoration without delay (instead of waiting until the
sentence is technically complete) if you meet every other condition. Governor McDonnell has processed applications by
individuals with suspended sentences, and has not stated that a suspended sentence will prevent a person from
immediately submitting an application.
This means if you have a judgment for a suspended sentence, and do not serve a jail, prison, or other confinement
sentence, then the two year or five year waiting period immediately begins assuming that you have paid all of your
fines, court costs, etc. If you have a judgment for a suspended sentence, and serve a jail, prison or other confinement
sentence, the two-year or five-year waiting period immediately begins upon your release from confinement, assuming
that you have paid all of your fines, court fees, etc. If you have a judgment for a suspended sentence, and either have no
confinement sentence, or have finished your confinement sentence, but have not paid your outstanding fines, court fees
or other financial obligations, then the two-year or five-year waiting period does not begin until you have paid all of
your obligations.
3. Should I complete an application or petition the court?

Most people complete applications instead of petitioning to the Circuit Court. The application process is usually easier
and more straightforward. Submitting a Circuit Court petition can be quicker, but even if the court approves the petition,
the Governor still must approve it. The important part is to know that there are two channels for people with non-violent
felony convictions to restore their civil rights.
4. How long does the process take?
It depends on whether you submit an application or petition a Circuit Court. Governor McDonnells policy is to make
decisions on completed applications within 60 days. Many submitted applications are not accepted by the Secretary of
the Commonwealth (on behalf of the Governor) because they are considered incomplete (without all of the requested
materials). The Secretary of the Commonwealth has stated, however, that it can request some materials on the
applicants behalf, but doing so may delay the application. It is important to know if you submit a completed application
and your application is denied by the Governor, you must wait one-year before you can re-apply.
If you petition the Circuit Court it will take time for the court to review the petition. It could be weeks to months
depending on the court. Once a petition is approved by the court, the Governor must provide a decision within 90 days
from the courts ruling, under Virginia law.
Please keep in mind that these rules are not always observed, and it is your right to request that the Governor follow
his/her own rules or Virginia law.
5. If I restore my civil rights is that the same as a pardon? Does it expunge my record?
No. The restoration of your civil rights is not the same as a pardon or expungment. Neither is granted if you successfully
restore your rights. A pardon is a statement of official forgiveness by the Governor. An expungement is when a
conviction is removed from your criminal record. Both pardons and expungements are very rarely given (more so than
restoration of rights applications). If you restore your civil rights, however, you re-gain your right-to-vote, right to run
for public office, right to serve on a jury, and right to serve as a notary public.
6. How do I know whether my conviction is non-violent or violent or which application form to fill-out?
For some people whether your conviction was non-violent or violent is obvious. But for others it is not. Governor
McDonnell, through the Secretary of the Commonwealth, has provided a list of offenses which he considers nonviolent and violent online, which is in Appendix C of this guide.
For some people determining which application to fill-out is hard because you may have non-violent and violent
convictions. If this is the case, you should fill-out the violent application.
One important thing to keep in mind is that there is a slightly different list for the court petition process than for the
application process. Please check Appendices C & D for each list.
7. Can I restore my right to carry a firearm through this process?
No. It is illegal for any person convicted of a felony to possess or transport a firearm or carry a concealed weapon in
Virginia. To restore this right you must first restore your civil rights, and then you must petition the court for a firearm
permit. It is a separate process from civil rights restoration.
8. Is the process to restore civil rights in Virginia the same as other states?
No. Virginia is one of four states which permanently remove a persons civil rights, including the right-to-vote, after
being convicted of a felony. Most states allow some people to have their rights automatically restored once they serve
their sentence. For more information about rights restoration, visit The Sentencing Projects page on Voting Rights,
at http://www.sentencingproject.org/template/page.cfm?id=133.
Part 2: Short Application for Non-Violent Convictions

You need to answer yes to all of the below questions in order to successfully submit short application:
(1)
(2)
(3)
(4)
(5)
Was conviction for a felony offense?

Was it a non-violent offense?
Has it been at least two years since completion of the felony sentence?
Has it been at least two years since any subsequent conviction, whether felony or misdemeanor?
Have all court costs, fines and restitution been paid?
Note: Even if all of the answers to above questions are yes, the Governor still has discretion to reject the
application.
(1)
Was the conviction for a felony offense?
Voting rights are only taken away for felony convictions. Misdemeanor offenses do not strip you of your civil rights. If
you were convicted of a felony offense, go to question 2. If no, you have still have your civil rights.
Note: If you are not sure whether your conviction is a felony or a misdemeanor, please see Appendix C, in the back of
this guide. If you are still are not sure, please call the Clerk of the Virginia Circuit Court in which you were convicted.
If you were not convicted by a Virginia court, please call the Clerk of the Virginia Circuit Court where you currently
reside. We have provided a list of Clerks in Appendix E.
(2)
Was the conviction for a non-violent offense?
If you choose to apply for restoration there is a short application for non-violent convictions and a long application for
violent convictions. Some drug convictions and election-related convictions are considered violent.
If you were convicted of a non-violent felony, go to question 3. If you were convicted of a violent felony, go to Part 3,
question 2, on page 5.
If you are not sure whether your conviction qualifies as non-violent or violent, please Appendix C. If you are still
unsure, contact the Micah Womak, Director of Rights Restoration, or Candice Reid, Assistant Director, at the
Secretary of the Commonwealth office, at (804)786-2441. If you do not receive a reply, please contact Advancement
Project at 1-855-LET-VOTE.
(3)
Has it been at least two years since your sentence for the felony conviction was completed (including
parole, probation, and the payment of court-imposed fees)?
If yes, go to question 4. If no, you must wait until this time period has passed before you can apply.
(4)
Have you been free from any convictions, including both felonies and misdemeanors, in the last two
years?
If yes, go to question 5. If no, you need to submit a long application explained in Part 3.
(5)
Have all court costs, fines and restitution been paid?
If yes, you should be eligible to complete the short application, please see Appendix A. If no, these must be paid
in order to submit an application.
If no, you are not eligible to complete the short application until you have paid all of your court fines, restitution, and
fees.
If you are not sure please contact either the Clerk of the Court in which you were convicted. If your conviction was not
in a Virginia Circuit Court, please call the Circuit Court where you reside. If you are on parole or probation, your
officer should be able to assist you.
Part 3: Long Application for Violent, Election Law, Certain Drug and All Other Offenses
For violent, election law, and certain drug felony offenses, successful use of the long application requires an
answer of yes to the following questions:
(1)
(2)
(3)
(4)

Has it been at least five years since completion of felony sentence (including suspended sentences,
probation and parole)?
Have there been no subsequent convictions for felony or misdemeanor offenses in the last five years?
Have all court costs, fines, and restitution been paid?
Note: Even if all of the answers to above questions are yes, the Governor still has discretion to reject the
application.
(1)
you were convicted of a felony offense, go to question 2. If no, you still have your civil rights.
Note: If you are not sure whether your conviction is a felony or a misdemeanor, please see Appendix C. If you are still
are not sure, please call the Clerk of the Virginia Circuit Court in which you were convicted. If you were not convicted
by a Virginia court, please call the Clerk of the Virginia Circuit Court where you currently reside. We have provided a
list of Clerks in Appendix E.
(2)
Has it been at least five years since you completed your felony sentence (including probation, parole or
the payment of court-imposed fees)?
If yes, go to question 3. If no, you may need to wait until five years has passed since your most recent conviction
before you can apply.
Note: Technically this question refers only to felony convictions. If you have had a misdemeanor conviction, however,
within five years since you completed your felony sentence, then your application will most likely NOT be approved.
Ultimately, you should make your own decision about whether to still submit your application. Please keep in mind
that if you submit an application and your application is rejected there is a one-year mandatory waiting period until
you can re-apply.
(3)
Have you had a felony or misdemeanor conviction in the last five years?
If no, go to question 4. If no, you may need to wait until this time period has passed before you can apply.
Note: Technically this question only refers to convictionscharges that have been accepted by guilty plea or under
which a jury or judge has found you guilty in a trial. If, however, you have a misdemeanor case that is continued
(postponed) and scheduled to be dismissed, the application will most likely NOT approved until the case is actually
dismissed. Ultimately, you should make your own decision about whether to still submit your application. Please keep
in mind that if you submit an application and your application is rejected there is a one-year mandatory waiting period
until you can re-apply.
(4)
Have all court costs, fines, and restitution been paid?
If yes, you are eligible to complete the long application, please see Appendix B. If no, costs must be paid to
submit an application.
If no, you are not eligible to complete the long application until you have paid all of your court fines, restitution, and
fees.
If you are not sure, please contact either the Clerk of the Court in which you were convicted. If your conviction was
not in a Virginia Circuit Court, please call the Circuit Court where you reside. If you are on parole or probation, your
officer should be able to assist you.
Where should I send my completed application?
Once completed, the application should be sent to:
Secretary of the Commonwealth
Attn: Clemency Division
Post Office Box 2454
Richmond, Virginia 23218-2454
After the Secretarys Office determines that your application meets the eligibility requirements, it is forwarded to the
Governor for final approval.
Where can I find more information about the application process?
More information can be found at:
http://www.commonwealth.virginia.gov/JudicialSystem/Clemency/restoration.cfm.
State government contact:
Micah Womak, Director of Rights Restoration or Candice Reid, Assistant Director
Office of the Secretary of the Commonwealth
(804)786-2441
Additional assistance can be provided by:
Advancement Project
1220 L Street NW, Suite 850
Washington DC, 20005
1-855-LET-VOTE
Part 4: Petition to Court for Non-Violent Offenses

A petition is simply a request for restoration of voting rights submitted to the court.
In deciding whether to approve a petition, the court will evaluate answers to the following questions:
In order to successfully petition the court, the answers to the following questions should be yes.
(1)
(2)
Was the felony conviction for a non-violent offense?
(3)
Has it been at least 5 years since completion of the felony sentence (including probation, parole, and
court-imposed fees)?
(4)
Has the person demonstrated civic responsibility through community or comparable service?
(5)
Have there been no other subsequent criminal convictions for felony of misdemeanor offenses
(excluding traffic violations) in the last five years?
Note: Even if petition is approved by court, the Governor still has discretion to reject application.
(1)
you were convicted of a felony offense, go to question 2. If no, you still have your civil rights.
Note: If you are not sure whether your conviction is a felony or a misdemeanor, please see Appendix C, in the back of
this guide. If you are still are not sure, please call the Clerk of the Virginia Circuit Court in which you were convicted.
If you were not convicted by a Virginia court, please call the Clerk of the Virginia Circuit Court where you currently
reside. We have provided a list of Clerks in Appendix E.
(2)
Was conviction for a non-violent offense?
People with felony convictions for violent, certain drug and/or election-related offenses, as defined by Virginia law,
CANNOT petition the court. To learn whether your conviction is eligible for petition restoration, please see Appendix
C.
If yes, (your conviction was for a non-violent offense), go to question 3.
If no, you cannot submit a petition. But you may still apply directly to the Governor. Please see Part 3 on page 6.
Note: Remember that violent, certain drug, and election-related offenses are defined differently for the petitioning
process than for the application process. Please see Appendix D for a complete list.
(3)
Did you complete your felony sentence (including probation, parole or paid cost-imposed fees) at least
five years ago?
If yes, go to question 4. If no, then the court will most likely reject the petition. But you may still apply directly to
the Governor. Please see Part 3 (page 6).
(4)
Have you demonstrated civic responsibility through community or comparable service?
This question requires the court to make its own judgment about whether you have shown civic responsibility. If you
believe that you have contributed to your community and can show this, go to question 5.
If you have not, then the court will most likely reject the petition. Ultimately, you should make your own decision
about whether to still file a petition. Also remember that you can always submit an application to the Governor. Please
see Part 3 (page 6).
(5)
Have you been convicted of a criminal offense (excluding traffic violations) in the past five years?
If no, then you are likely to have a successful Circuit Court petition.
If yes then the court will most likely reject the petition. Ultimately, you should make your own decision about
whether to still file a petition. Also remember that you can always submit an application to the Governor. Please see
Part 3 (page 6).
Please see Appendix E for a list of Virginia Circuit Courts. Detailed instructions on how to petition a Circuit
Court are in Appendix F.
ADVANCEMENT PROJECT VIRGINIA CIVIL RIGHTS

RESTORATION GUIDE APPENDICES
1. Appendix A: Non-Violent Offenses: Instructions and Application
2. Appendix B: Violent, Certain Drug, or Election-Related Offenses: Instructions and Application
3. Appendix C: Secretary of the Commonwealth List of Non-Violent and Violent Offenses for the
Application Process
4. Appendix D: List of Violent, Certain Drug, and Election-Related Offenses By Virginia Code (Disqualify
from Use of Virginia Courts to Petition)
5. Appendix E: Virginia Circuit Court Contact Information
6. Appendix F: Circuit Court Petition Filing Steps
7. Appendix G: Notary Public Information
8. Appendix H: Department of Motor Vehicle Instructions on Obtaining Identification (Non-Drivers License
ID)
9. Appendix I: Instructions for Requesting A Copy of Your Birth Certificate/ Individuals Who Need to
Correct Their Gender on a Birth Certificate
Restoration of Civil Rights

Nonviolent Offenders Application
VIRGINIA RESTORATION OF CIVIL RIGHTS APPLICATION FORM
Use this form to apply for restoration of civil rights.
To apply for restoration of civil rights, you must:
Be a resident of Virginia, and/or have been
convicted of a felony in a Virginia court, a U.S.
District Court, or a military court
Have paid all costs, fines, and/or restitution
associated with your convictions.
Complete a two (2) year waiting period after
completion of sentence and/or release from
supervised probation or parole
Not have any misdemeanor and/or

pending criminal charges (excluding traffic
convictions) within the past two (2) years
immediately preceding the application
Not have a conviction for DWI within the
past five (5) years immediately preceding
the application
Persons who have been convicted of a violent offense, a drug manufacturing or distribution offense, crimes
involving children, or an election law offense are not eligible for this process using this form.
Call (804) 7862441 or go online to www.commonwealth.virginia.gov to get the appropriate form.
The Secretary of the Commonwealth will conduct a criminal history and DMV check on all applicants.
The civil rights restored through this process include the rights to:
Register to vote
Hold public office
Serve on a jury
Serve as a notary public
The restoration of rights does not restore the right to possess a firearm. You must petition the appropriate
circuit court pursuant to Va. Code 18.2308.2.
It also does not expunge a criminal charge, which can only be done by petitioning a circuit court pursuant to Va. Code
19.2392.1 and 19.2392.2.
This is not a pardon. A person who has been convicted of a felony must first have his or her rights restored in order to
be considered for a simple pardon.
Applicants residing outside the Commonwealth of Virginia must include a certified copy of their Driving and
Criminal Record from the state they reside.
In an effort to significantly expedite the decision making process, if you have a certified copy of the felony sentencing
order and proof of payment of court ordered costs, fines and/or restitution, you may include that with the application. If
not included, the Office of the Secretary of the Commonwealth will request such copies from the appropriate court. The
Secretary of the Commonwealth will also request the required information from the petitioners probation officer, if
applicable. The application will not be considered to be complete until the Secretary of the Commonwealth receives
such information.
If there is any additional information you would like to provide the Governor for consideration of your request, please
feel free to do so.
The Governor has the sole discretion to restore a persons civil rights under the Virginia Constitution. There is no
process for appealing his decision. A person who has been denied may reapply after one year. The goal of the
Administration is to have all decisions made within 60 days of the receipt of a complete and eligible application, with
written notice given to the applicant.
If you have any questions, please call (804) 7862441 or write to the address provided.
Mail to: Restoration of Rights, Secretary of the Commonwealth, P.O. Box 2454, Richmond, VA 23218
Application for Restoration of Rights for Certain Nonviolent

Offenders
Legal Name Now Used (Please Print):
__________________________________________________________________________Male_____Female_____
Name as Convicted (Please Print):
______________________________________________________________________________________________
Date of Birth: ________________________________ Social Security Number: _______________________________
Street Address:
______________________________________________________________________________________________
City, State and
Zip__________________________________________________________________________________________
Mailing Address (if different from
above):_______________________________________________________________
Home Phone: __________________ Work Phone: ___________________ Cell Phone:___________________
Email (if available): _____________________________________________
Please indicate above by checking the appropriate box (check all that apply) the number where you may be reached
should we need additional information.
Felony Offense(s) for Which you seek Restoration of Rights:
______________________________________________________________________________________________
______________________________________________________________________________________________
Please provide a brief description of community or comparable service or any other information you would like the
Governor to
know (optional):
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Court in Which Convicted: __________________________ County/State: __________________________________
__________________________________________________
community or comparable service:___________________________________________________________________
Date(s) of Sentence
(MM/DD/YYYY): __________________________
Date of Release from
Supervised Probation,
if any (MM/DD/YYYY): _________________________
Instructions: This affidavit must be signed in the presence of a notary public or other official empowered to
administer an oath.
AFFIDAVIT
I, the undersigned, do solemnly swear (or affirm) that the information on this application, including all attachments, is
complete, accurate, and true.
________________________________________________
Signature of Applicant
Commonwealth of Virginia
City/County of ____________________
Subscribed and sworn before me this_____ day of ______________________________ year______________.
___________________________________________
Notary Public
My Commission Expires: ___________________________
Restoration of Civil Rights

Five Year Application Instructions
PLEASE READ CAREFULLY:
Persons who have been convicted of a violent offense, a drug manufacturing or distribution offense, an
offense against a minor, or an election law offense must use this form to apply for restoration of rights.
Current policy states that in order to be eligible for the restoration of rights by Governor Robert F.
McDonnell, an applicant must be free from supervised probation and not have any convictions or charges
pending for a period of five (5) years immediately preceding the application. No application is considered
if there is a charge pending or a conviction for Driving While Intoxicated for a period of five (5) years
immediately preceding the application.
To apply for restoration of rights, you must:
Be a resident of Virginia, and/or have been convicted of a felony in a Virginia court, a U.S. District
Court, or a military court
Have paid all costs, fines, and/or restitution associated with your convictions
Not have a misdemeanor or pending conviction within the five (5) years immediately preceding the
application.
The Secretary of the Commonwealth will conduct a criminal history and DMV check on all applicants.
The civil rights restored through this process include the rights to:
Register to vote
Hold public office
Serve on a jury
Serve as a notary public.
The restoration of rights does not restore the right to possess a firearm. You must petition the appropriate
Circuit Court pursuant to Va. Code 18.2-308.2. It also does not expunge a criminal charge, which can only
be done by petitioning a Circuit Court pursuant to Va. Code 19.2-392.1 and 19.2-392.2.
This is not a pardon. A person who has been convicted of a felony must first have his or her rights restored
in order to be considered for a simple pardon.
Applicants residing outside the Commonwealth of Virginia must include certified copies of their Driving
Record and Criminal Record from the state they reside.
The Governor has sole discretion to restore civil rights. There is no process for appealing his decision. A
person who has been denied may reapply after one year from his or her denial date.
This packet contains the necessary forms to petition the Governor for the restoration of your rights. Please
read all information and instructions carefully.
If you think you are eligible to have your rights restored, complete all the forms, assemble the documents,
and return them to this office. There are no costs or fees required of you as a petitioner.
If you have questions about your eligibility, contact:
Restoration of Rights
P. O. Box 2454
Richmond, VA 23218
Phone: (804) 786-2441
THE SECRETARY OF THE COMMONWEALTH WILL NOT ACCEPT INCOMPLETE APPLICATIONS
QUESTIONS AND ANSWERS ABOUT RESTORATION OF CIVIL RIGHTS
HOW DO I KNOW IF I HAVE LOST MY CIVIL RIGHTS?
You have lost your civil rights if you have ever been convicted of a felony in:
Any Virginia court;
Any court of any other state or the District of Columbia;
Any federal court;
Any court of an associated commonwealth, territory, or possession of the United States.
You have not lost your civil rights if you have only been convicted of a misdemeanor or misdemeanors.
HOW DO I KNOW IF A CONVICTON WAS A FELONY?
Request a copy of your sentencing order from the Clerk of the Circuit Court in which you were
convicted. The sentencing order will state the charge for which you were convicted, the sentencing
date, and the original sentence information.
HOW DO I KNOW IF I AM ELIGIBLE TO HAVE MY RIGHTS RESTORED?
You are eligible if you:
Have completed all prison or jail terms;
Are not presently under probation or parole supervision;
Have no pending charges in any locality;
Have paid all fines, restitution, and/or court costs associated with convictions
Have been free of any parole or supervised probation for the last five years, and
Have not had any misdemeanors or pending convictions in the last five years.
If you do not know the status of fines, restitution, and/or court costs, you will need to consult the Clerk
of the Court in which you were convicted.
WHAT IF I STILL OWE COURT COSTS?
If you are still under an order to pay court costs, fines, and/or restitution as a condition of your
sentence, you may not have your rights restored. You must show proof of payment of all court costs,
fines, or restitution before being eligible to apply for restoration of your civil rights.
WHAT IS THE DIFFERENCE BETWEEN A RESTORATION OF RIGHTS AND A PARDON?
Restoration of civil rights, if granted, will fully restore citizenship. It removes all civil disabilities and
disqualifications imposed as a result of a felony conviction. These rights include the right to vote, to
run for and hold public office, to serve on juries, and to serve as a Notary Public. A restoration of rights
may allow you to apply for a pardon.
A pardon is an act of official forgiveness and is granted only in exceptional cases. It often serves as a
means for the petitioner to advance in employment, education, and self-esteem.
WILL THE RESTORATION OF MY CIVIL RIGHTS RESTORE MY RIGHTS TO POSSESS OR
TRANSPORT ANY FIREARM OR TO CARRY A CONCEALED WEAPON?
No. A person convicted of a felony under the laws of Virginia, or any other state or under federal law
may not possess or transport any firearm or carry a concealed weapon (defined to include both
handguns and long guns).
To regain state firearms privileges, a convicted felon may apply to the Circuit Court of his residence for
a permit to possess or carry a firearm. The court in its discretion and for good cause shown may grant
the petition. If your conviction, however, was for a federal offense, you may only seek restoration of
your firearms privileges through the federal system.
While the Governor has the authority to restore state firearms privileges expressly by a pardon or
though restoration of political rights, he does not customarily do so.
INSTRUCTIONS
APPLICATION for RESTORATION of CIVIL RIGHTS
Item A: Print your full name, as you are now known. If you have ever changed your name, see
instructions for Item B.
Item B: If you have ever had your name legally changed since the time of a prior conviction, print the
name under which you were convicted. Also, if you were ever convicted under an alias, print the alias
name on this line.
Item C: Print your date of birth and Social Security Number.
Item D: If you were an inmate in the Virginia Department of Corrections, print your prison number (if
known) on this line. If you were an inmate in any other system, print the name of the state or other
authority beside the number.
Item E: Print your present home address street number or post office box.
Item F: Print the city and state where you reside.
Item G: Print your mailing address if different from above.
Item H: Print your present home and work telephone numbers, including the area codes.
Item I: Print your present cell phone number and email address if you wish to include either or both.
Item J: Print your present employers name.
Item K: Print your present employers address.
Obtain a letter from your most recent Probation or Parole officer outlining your period of supervision.
This letter should be addressed to the Governor, c/o Secretary of the Commonwealth, and may be
mailed with your application or mailed directly from the Probation/Parole office. If your officer has
retired or is no longer working in that office, call the Probation/Parole office that you reported to and
explain to them that you are applying to have your rights restored. They will know what type of letter
to provide.
Request a copy of your Pre-sentence Report, if applicable, from your supervising Probation or Parole
officer/office. The Probation or Parole officer/office will send this directly to the Secretary of the
Commonwealths Office. You will not receive a copy of this report. If there is no Pre-sentence Report
available, or one was not ordered by the court to be prepared for sentencing, you must obtain a letter
on the Probation/Parole office letterhead indicating it is not available or was not ordered by the court.
It is very important that you list each felony conviction on the application.
If you do not have this information, you may obtain it from your Probation and Parole Officer, the
Clerk of the Court in which you were convicted or through requesting a copy of your criminal record.
If you cannot list all convictions on the application, put the remainder on a separate sheet of paper and
attach this to the application.
You must attach certified copies of every sentencing order for each felony conviction on your record.
These may be obtained from the Clerk of the Court in which you were convicted. NOTE: Your order of
conviction and sentencing order may be the same document.
If you have ever had a sentence terminated by any court, or if you have ever had your probation or
parole terminated, you should obtain and attach certified copies of any court order or other official
document modifying that term.
LETTER OF PETITION
Read and sign the letter of petition. Be sure to put the date on the proper line.
LETTERS OF REFERENCE
Take the three (3) letters of reference to three (3) reputable people who live in your home community.
Be certain these are people who know you well enough to certify your good character. Good people to
ask for references might be:
Your employer or job supervisor;

A local businesswoman or businessman;
Your minister, priest, rabbi, or other spiritual advisor;
A leader of a local civic group;
A state or local public official; or
A law enforcement officer.
Have each person answer the questions in the letter and sign and date it at the bottom.
Ask each person to return the letter to you. You must return the three (3) letters with your application.
NOTE: Family members or in-laws may NOT sign these letters of reference. It is not necessary to
explain the purpose of the letter of reference to the people who sign it, but they may wish to know. The
decision to tell them is up to you.
LETTER TO THE GOVERNOR
Please provide the Governor with a letter describing the circumstances of your offense, community or
comparable service and any other information you may want the Governor to know when reviewing
your petition. This letter may be prepared by a family member, friend, attorney, or civil organization
representative and signed by you.
___________________________________________________________________________________________
APPLICANTS PETITIONING OUTSIDE OF THE COMMONWEALTH OF VIRGINIA
Please provide the Governor with the following documents:
A certified copy of your Driving Record from the state in which you reside
A certified copy of your Criminal Record from the state in which you reside
If a conducted search has returned NO record of a criminal history, please submit certified
documentation stating such.
Mail your application to:

P. O. Box 2454
Richmond, VA 23218
Make certain you have included the following:
The
application, completely filled out, signed and notarized
Certified
copies of all felony sentencing orders
Certified
proof of payment for any fines, restitution and/or court costs
The
letter of petition, signed and dated
Three
letters of reference, completed, signed and dated by three (3) reputable citizens
current letter from your most recent Probation or Parole officer/office, addressed to the Governor,
outlining your period of supervision
A
letter to the Governor describing the circumstances of your offense, community or comparable
service and any additional information you may want the Governor to know when reviewing your
petition
If
you are an applicant living outside the Commonwealth of Virginia, attach certified copies of your
Driving Record and Criminal Record from the state you reside.
If applicable, please be sure to request your Pre-sentence Report from your Probation or Parole
officer/office. They will send this directly to the Secretary of the Commonwealths Office.
Violent Offenders / Drug Offenders / Election Law Offenders Application
Before filling out this application, be sure to read the instructions thoroughly and print or type the complete information
in each blank. If a question does not apply, put N/A in the blank. Attach certified copies of all required documents to
this application. The affidavit on the reverse side must be signed in the presence of a notary public or other official
empowered to administer oaths.
A. Legal Name Now Used (Please Print): ____________________________________________________
B. Name as Convicted (Please Print): ______________________________________________________
C. Date of Birth: _________________________ Social Security Number: __________________________
D. Prison Number (If any): _______________________________________________________________
E. Home Address: _____________________________________________________________________
F. City and State: _____________________________________________________________________
G. Mailing Address: _____________________________________________________________________
H. Home Phone: ______________________________Work Phone: ______________________________
K. Cell Phone: _________________________Email (If any): ____________________________________
J. Present Employer: ___________________________________________________________________
K. Employers Address: _________________________________________________________________
Felony Offense(s): _________________________________________________________________

Court: ____________________________________
County/State: ____________________________________
Date(s) of Conviction: __________________________ Date(s) of Sentence: __________________________

Incarceration (If Applicable): _______________________ Supervised Probation or Parole: _____________________
If necessary, you may use the space below to include additional information.
1. If you were on supervised probation or parole:

___Obtain a letter from the District Probation/Parole office outlining your period of supervision or parole.
___IF a Pre-sentence Report was prepared, request that the Probation/Parole office forward this report to:
Restoration of Rights, Secretary of the Commonwealth P.O. Box 2454, Richmond, VA 23218. Please Note:
The Pre-sentence Report will not be directly given to the applicant but mailed upon your request to the
Secretary of the Commonwealths Office.
2. ___Attach a certified copy of the sentencing order for each felony conviction.
3. ___Attach a certified copy of each order that modifies or changes the sentencing order for each felony conviction,
if applicable. This includes any order reducing or terminating any sentence, suspended sentence, or any term of
probation.
4. ___Attach certified receipt (s) of proof of payment of any fines, court costs, or restitution.
5. ___Attach a letter addressed to the Governor describing the circumstances of your offense, community or
comparable service and any other information you may want the Governor to know when reviewing your petition.
6. Have you ever had your rights restored for any criminal conviction in Virginia or any other state? ___YES ___NO (If
you have checked YES, please attach document)
7. Have you ever had been granted a pardon for any criminal conviction in Virginia or any other state? ___YES ___NO
(If you have checked YES, please attach document)
8. Have you completed all prison/jail terms, probation or parole, and/or supervised release for a minimum of five (5)
years? ___YES___NO (If the answer is NO, you may not be eligible for this process at this time)
Instructions: This affidavit must be signed in the presence of a notary public or other official empowered to
administer an oath.
AFFIDAVIT
I, the undersigned, do solemnly swear (or affirm) that the information on this application, including all attachments, is
complete, accurate, and true.
________________________________________________
Signature of Applicant
City/County of ____________________
Subscribed and sworn before me this_____ day of ______________________________ year______________.
___________________________________________
Notary Public
My Commission Expires: ___________________________
Mail this application and all required documentation to:

P.O. Box 2454, Richmond, VA 23218
LETTER OF PETITION
Governor of Virginia
c/o Secretary of the Commonwealth
Richmond, VA 23218
Date:________________
Dear Governor:
I am enclosing my application for the restoration of my civil rights. I believe that the information contained
herein is complete and accurate. I understand that an incomplete or ineligible application will not be accepted and
may be returned to me.
I have attached certified copies of all orders of conviction and/or sentencing pertaining to my felony
conviction(s), as well as all other required documents. In addition, I am submitting three letters of reference from
reputable citizens who can attest to my character and reputation in the community.
I believe that my application will prove that I have earned the privilege to have my civil rights restored. I
understand that the decision to restore my rights is vested solely in the office of the Governor of Virginia.
Thank you for your consideration.
Respectfully yours,
_______________________________
Signature
________________________________
Address
________________________________
City, State, Zipcode
Letter of Reference
_______________________________
Print Name
________________________________
Occupation or Title
________________________________
Address
________________________________
City, State, Zip code
Richmond, VA 23218
Dear Governor:
I am writing at the request of __________________________________ whom I have known personally for
__________________ years. I am not a relative by birth or by marriage, and I believe that he/she is a law abiding
citizen of good character. My relationship with the applicant is
________________________________________________________, and I am enclosing additional comments
below:
I hope this information will be helpful to you.
Respectfully,
_______________________________
Signature of Reference
Letter of Reference
_______________________________
Print Name
________________________________
Occupation or Title
________________________________
Address
________________________________
Richmond, VA 23218
Dear Governor:
below:
Respectfully,
_______________________________
Letter of Reference
_______________________________
Print Name
________________________________
Occupation or Title
________________________________
Address
________________________________
Richmond, VA 23218
Dear Governor:
below:
Respectfully,
_______________________________
APPENDIX C
Secretary of the Commonwealth List of Non-Violent and Violent Offenses for the Application Process
Source: http://www.commonwealth.virginia.gov/JudicialSystem/Clemency/restoration.cfm
Felony convictions for which an applicant must complete the 2-Year Application:
Embezzlement
Welfare Fraud
Habitual Offender
Grand Larceny
Drug Possession (must not be Drug Possession with the Intent to Distribute)
Breaking and Entering
Burglary/Statutory Burglary/Possession of Burglarious Tools
Obtain Money by False Pretenses
Prescription Fraud/Obtain Drugs by Fraud
Petit Larceny, 3rd or Subsequent Offense
Felonious Shoplifting/Concealment/Price Altering
Driving Under the Influence or Driving While Intoxicated, 3rd or Subsequent Offense
Credit Card Theft/Credit Card Fraud/Credit Card Forgery
Identity Theft
Mail Theft/Mail Fraud
Bank Fraud
Issuing Bad Checks/Worthless Checks
Felony Eluding Police
Forgery
Uttering
Perjury
False Statement on Firearm Transaction Record
Unlawful Possession of a Concealed Weapon
Felony convictions for which an applicant must complete the 5-Year Application:
Drug Possession with the Intent to Distribute

Drug Distribution
Drug Manufacturing
Robbery
Malicious/Unlawful Wounding
Felonious Assault
Maiming
Murder
Manslaughter Involuntary or Voluntary
Production, publication, sale, financing, etc., of child pornography
Shooting into an Occupied Vehicle or Building
Arson of an Occupied Vehicle or Building
Hit & Run/Leaving the Scene of an Accident with Injury
Election Fraud
Rape
Forcible Sodomy/Sodomy of a Minor
Carnal Knowledge of a Minor
Carnal Knowledge of an Inmate by Correctional or Law Enforcement Officer
Breaking and Entering with Intent to Commit Rape or Assault
Accommodation Sale of a Controlled Substance
Child Abuse/Neglect
APPENDIX D
Offenses Preventing the Use of Virginia Courts to Restore Voting Rights (Violent Crimes)
Offense
First and second degree murder and voluntary manslaughter
Mob-related felonies
Kidnapping or abduction felonies
Malicious felonious assault or malicious bodily wounding
Felony criminal sexual assault
Arson when structure occupied
Capital murder
First and second degree murder
Felony homicide
Voluntary manslaughter
Aggravated involuntary manslaughter
Mob lynching
Mob shooting, stabbing, etc., with intent to kill
Shooting, stabbing, etc., with intent to kill
Malicious bodily injury to law enforcement officers
Aggravated malicious wounding
Reckless endangerment of other by throwing objects from high places
Malicious bodily injury by caustic substance or explosive
Possession of infectious biological substances
Shooting, etc. in committing or attempting a felony
Use or display of firearm in committing a felony
Attempts to poison
Adulteration of food, drink, drugs, cosmetics, etc.
Bodily injury caused by prisoners, probationers, or parolees
Felony assault and battery against a family or household member
Felony threatening the Governor or his family
Felony stalking
Rape
Carnal knowledge of certain minors
Forcible sodomy
Object sexual penetration
Marital sexual assault
Aggravated sexual battery
Attempted rape, forcible sodomy, object sexual penetration, aggravated sexual
battery, and sexual battery
Third misdemeanor conviction of sexual battery or attempted sexual battery
Class 4 felony Carnal knowledge of childe between 13 and 15 years of age
Burning or destroying dwelling house, etc., if occupied
Class 3 felony burning or destroying meeting house
Class 3 felony burning or destroying any other structure
Burglary
Entering dwelling house, etc. with intent to commit murder, rape, or robbery
Entering dwelling house, etc. with intent to commit larceny, assault and battery, or
other felony
Breaking and entering dwelling house with intent to commit other misdemeanor
Entering bank, armed, with intent to commit larceny
Felony personal trespass by computer
VA Code Provision
18.2-30, et seq.
18.2-38, et seq.
18.2-47, et seq.
18.2-51, et seq.
18.2-61, et seq.
18.2-77, 18.2-79
18.2-31
18.2-32
18.2-33
18.2-35
18.2-36.1(B)
18.2-40
18.2-41
18.2-51
18.2-51.1
18.2-51.2
18.2-51.3
18.2-52
18.2-52.1
18.2-53
18.2-53.1
18.2-54.1
18.2-54.2
18.2-55
18.2-57.2
18.2-60.1
18.2-60.3
18.2-61
18.2-64.1
18.2-67.1
18.2-67.2
18.2-67.2:1
18.2-67.3
18.2-67.5
18.2-67.5:1
18.2-63
18.2-77(A)
18.2-79
18.2-80
18.2-89
18.2-90
18.2-91
18.2-92
18.2-93
18.2-152.7
Class 4 felony obstructing or injuring canal, railroad, power line, etc.

Class 4 felony shooting at or throwing missiles, etc. at train, car, vessel, etc.
Class 4 felony injuring, etc., signal used by railroad
Felony damage or trespass to public services or utilities
Discharging firearms or missiles within or at occupied building or dwelling house
Willfully discharging firearms in public places, at or near a school
Setting spring gun or other deadly weapon
Shooting from vehicle so as to endanger persons
Use of machine gun for crime of violence
Use of machine gun for aggressive purpose
Felony pointing holding or brandishing firearm of object similar in appearance so
as to induce fear in the mind of another of being shot
Possession or use of sawed-off shotgun in commission of crime of violence
Felony possession of firearm, stun weapon, or other weapon on school property
Felony possession or transportation of firearms or concealed weapons by convicted
felons
Violations of prohibitions on selling firearms to certain persons
Purchase of a firearm with intent to resell to certain persons; or solicitation, by a
person ineligible to purchase a firearm, of another to purchase a firearm on his or
her behalf
Use or attempted use of restricted ammunition in commission or attempted
commission of crimes
Illegal use of tear gas, phosgene and other gases
Taking, detaining, etc. a person against their will for prostitution etc.; consenting as
a parent or guardian to the taking, detaining, etc. of a person for prostitution, etc.
Detaining male or female in bawdy place against his or her will
Sodomy with an immediate relative
Fornication with an immediate relative
Placing or leaving wife for prostitution
Taking indecent liberties with children
Taking indecent liberties with child by person in custodial or supervisory
relationship
Willful abuse and neglect of children causing serious injury to life or health
Felony abuse and neglect of incapacitated adults, resulting in serious bodily injury
or disease
Production, publication, sale, possession with intent to distribute, financing, etc., of
sexually explicit items involving children
Felony possession of child pornography
Use of electronic means to facilitate certain offenses involving children
Any second or subsequent offense for employing or permitting a minor to assist in
any obscenity related offense
Felony rioting
Felony unlawful assembly
Conspiracy to incite, etc., a riot
Commission of certain offenses in county, city, or town declared by Governor to
be in state of riot or insurrection
Injury to property or persons by persons unlawfully or riotously assembled
Paramilitary activity
Felony obstruction of justice
Felony delivery of drugs, firearms, explosives, etc. to prisoners
Felony escapes from juvenile facility
18.2-153
18.2-154
18.2-155
18.2-162
18.2-279
18.2-280
18.2-281
18.2-286.1
18.2-289
18.2-290
18.2-282
18.2-300
18.2-308.1
18.2-308.2
18.2-308.2:1
18.2-308.2:2
18.2-308.3
18.2-312
18.2-355
18.2-358
18.2-361
18.2-366
18.2-368
18.2-370
18.2-370.1
18.2-371.1(A)
18.2-369
18.2-374.1
18.2-374.1:1
18.2-374.3
18.2-379
18.2-405
18.2-406
18.2-408
18.2-413
18.2-414
18.2-433.2
18.2-460
18.2-474.1
18.2-477.1
Prisoner escaping from jail

Escape from jail or custody by force or violence without setting fire to jail
Escape without force or violence or setting fire to jail
Escape, etc., by setting fire to jail
Conspiring to incite one race to insurrection against another race
Felonies by prisoners
Felony manufacturing, selling, giving, distributing or possessing with intent to
manufacture, sell, give or distribute a controlled substance or an imitation
controlled substance
Felony transporting controlled substances into Virginia
Felony sale, gift, distribution, or possession with intent to sell, give or distribute
marijuana
Felony distribution of certain drugs to persons under 18
Felony sale of drugs on or near certain properties
Felony maintaining a fortified drug house
Felony making of false statement in connection with election forms, etc.
18.2-477
18.2-478
18.2-479
18.2-480
18.2-485
53.1-203
18.2-248
18.2-248.01
18.2-248.1
18.2-255
18.2-255.2
18.2-258.02
24.2-1016
APPENDIX E
Circuit Courts of Virginia1
County/City
Accomack
Clerk
Samuel H. Cooper Jr.
SHCooper@courts.state.va.us
Albemarle
Hon. Debra Shipp
Alexandria
Edward Semonian Jr.

ed.semonian@alexandriava.gov
Allegheny
Hon. Debra Byer

dbyer@courts.state.va.us
Amelia
Hon. Marilyn Wilson

mwilson@courts.state.va.us
Amherst
Hon. Roy C. Mayo III
Appomattox
Hon. Janet A. Robertson

jrobertson@courts.state.va.us
Arlington
Hon. Paul F. Ferguson

circuitcourt@arlingtonva.us
Augusta
Hon. John B. Davis

jbdavis@courts.state.va.us
Bath
Hon. M. Wayne Winebriner

wwinebriner@courts.state.va.us
Bedford
Hon. Cathy C. Hogan

chogan@courts.state.va.us
Bland
Hon. Rebecca I. Johnson

rijohnson@courts.state.va.us
Address
P.O. Box 126
Tel:
Courthouse Road
Fax:
Accomack, VA 23301-0126
Albemarle County Courthouse Tel:
Court Square
Fax:
501 East Jefferson Street
Charlottesville, VA 22902
Courthouse
Tel:
520 King Street
Fax:
Alexandria, VA 22314
Alleghany County
Tel:
P.O. Box 670
Fax:
Courthouse
266 W. Main Street
Covington, VA 24426-0670
P. O. Box 237
Tel:
Courthouse Square
Fax:
Amelia, VA 23002-0237
P. O. Box 462
Tel:
113 Taylor Street
Fax:
Amherst, VA 24521
297 Court Street, Suite B
Tel:
P.O. box 672
Fax:
Appomattox, VA 24522-0672
1425 N. Courthouse Road,
Sixth Floor, Suite 6700
Arlington, VA 22201
P. O. Box 689
Augusta County Courthouse
1 East Johnson Street
Staunton, VA 24402-0689
P. O. Box 180
Courthouse
Warm Springs, VA 244840180
123 East Main St.
Suite 201
Bedford, VA 24523
Judges' Address:
123 East Main St., Suite 301
612 Main Street, Suite 104
P. O. Box 295
Information obtained from www.courts.state.va.us/courts/courts.html.
Phone
757/787-5776
757/787-1849
434/972-4083
434/972-4085
434/293-0298
703/746-4044
(540) 965-1730
804/561-2128
804/561-6364
434/946-9321
434/946-9323
434/352-5275
434/352-2781
Tel:
703-228-7010
(Civil)
Fax:
Tel:
540/245-5321
Fax: 540/245-5318
Tel:
Fax:
540/839-7226
540/839-7248
Tel:
Fax:
540/586-7632
540/586-6197
Tel:
Fax:
276/688-4562
276/688-2438
Botetourt
Hon. Tommy L. Moore
Bristol
Hon. Terry G. Rohr

TRohr@courts.state.va.us
Brunswick
Hon. V. Earl Stanley Jr.

vesjr@telpage.net
Buchanan
Hon. Beverly S. Tiller
Buckingham
Hon. Malcolm Booker Jr.
Buena Vista
Hon. Christopher W. Coleman

ccoleman@courts.state.va.us
Campbell
Hon. Sheila Bosiger
Caroline
Hon. Ray S. Campbell Jr.
Carroll
Hon. Carolyn H. Honeycutt

CHoneycutt@courts.state.va.us
Charles City
Hon. Edith K. Holmes

ekholmes@courts.state.va.us
Charlotte
Hon. Stuart B. Fallen

SFallen@courts.state.va.us
Charlottesville
Hon. Paul C. Garrett
Chesapeake
Hon. Faye W. Mitchell

fmitchell@courts.state.va.us
Bland, VA 24315-0295
P. O. Box 219
Tel:
Courthouse
Fax:
Main Street
Fincastle, VA 24090-0219
Courthouse
Tel:
497 Cumberland Street
Fax:
Bristol, VA 24201
216 North Main Street
Tel:
Lawrenceville, VA
Fax:
23868-0160
P. O. Box 929
Tel:
Courthouse
Fax:
Grundy, VA 24614
13061 W. James Anderson
Tel:
Hwy
Fax:
P. O. Box 107
Buckingham, VA 23921-0107
Municipal Building
2039 Sycamore Avenue
Buena Vista, VA 24416
P. O. Box 7
732 Village Highway
Rustburg, VA 24588-0007
P. O. Box 309
112 Courthouse Lane, Suite A
540/473-8274
540/473-8209
276/645-7321
276/821-6097
434/848-2215
434/848-4307
276/935-6567
434/969-4734
434/969-2043
Tel:
540/261-8627
Ext. 127
Fax: 540/261-8625
Tel:
434/592-9517
Fax:
Tel:
Fax:
Bowling Green, VA 224270309

P. O. Box 218
Tel:
605 Pine Street
Fax:
Hillsville, VA 24343-0218
804/633-5800
276/730-3070
276/730-3071
P. O. Box 86
10780 Courthouse Road
Charles City, VA 230300086
Tel:
Fax:
804/652-2105
804/652-2107
804/829-5647
125 David Bruce Ave

P. O. Box 38
Charlotte Courthouse, VA
23923-0038
315 East High Street
Charlottesville, VA 22901
General District and Circuit
Court Building
307 Albemarle Dr., Suite
300A; Judges: Suite 400A
Tel:
Fax:
434/542-5147
434/542-4336
Tel:
434/970-3766
Fax:
Tel:
757/382-3000
Fax: 757/382-3034
Fax Criminal and Civil:
757/382-3035
Chesterfield
Chesapeake, VA 2 3322-5579 Judges Chambers:

757/382-3050
Hon. Judy L. Worthington
P. O. Box 125
Tel:
804/748-1241
circuitcourtclerk@chesterfield.gov 9500 Courthouse Road
Fax: 804/796-5625
Chesterfield, VA 23832-0125
Clarke
Hon. Helen Butts

hbutts@courts.state.va.us
Colonial Heights
Hon. Stacy L. Stafford

SStafford@courts.state.va.us
Craig
Hon. Sharon P. Oliver
Culpeper
Hon. Janice J. Corbin
Cumberland
Hon. Carol Ownby

COwnby@courts.state.va.us
Danville
Hon. Gerald A. Gibson
Dickenson
Hon. Richard W. Edwards
Dinwiddie
Hon. John B. Chappell Jr.

bchappell@courts.state.va.us
Hon. Gayle Ashworth
gashworth@courts.state.va.us
Essex
Fairfax
Hon. John T. Frey
Fauquier
Gail H. Barb
clerk@fauquiercounty.gov
Hon. Wendell G. Peters
Floyd
Fluvanna
Hon. Bouson E. Peterson Jr.

BPeterson@courts.state.va.us
Franklin
Hon. Teresa J. Brown
P.O. Box 57 (Judges)

P. O. Box 189
102 N. Church Street
Berryville, VA 22611-0189
401 Temple Ave
P.O. Box 3401
Colonial Heights, VA 23834
182 Main Street, Suite 4
P. O. Box 185
New Castle, VA 24127-0185
Tel:
Fax:
540/955-5116
540/955-0284
Tel:
Fax:
804/520-9364
Tel:
Fax:
540/864-6141
540/864-7471
Courthouse Bldg
135 W. Cameron Street
Culpeper, VA 22701-3097
P. O. Box 8
Cumberland, VA 230400008
P. O. Box 3300
Courts and Jail Building
401 Patton Street
Danville, VA 24543
Tel:
Fax:
540/727-3438
540/727-3475
Tel:
Fax:
804/492-4442
804/492-4876
Tel:
Fax:
(434) 799-5168
(434) 799-6502
Box 190
293 Main Street
Clintwood, VA 24228-0190
P. O. Box 63
Dinwiddie, VA 23841-0063
P. O. Box 445
305 Prince Street
Tappahannock, VA 22560
Jennings Building Judicial
Center
4110 Chain Bridge Road
Fairfax, VA 22030
29 Ashby St.
Warrenton, VA. 20186
100 E. Main Street
Room 200
Floyd, VA 24091
72 Main St.
P. O. Box 550
Palmyra, VA 22963
Tel:
Fax:
276/926-1616
276/926-6465
Tel:
Fax:
Tel:
804/469-4540
Tel:
Fax:
703/246-4111
703/691-7320
Tel:
Fax:
Tel:
Fax:
540/347-8610
540/347-0512
540/745-9330
540/745-9303
Tel:
Fax:
434/591-1970
434/591-1971
P.O. Box 567
Tel:
540/483-3065
804/443-3541
804/443-4381
tjbrown@courts.state.va.us
Frederick
Fredericksburg
Hon. Rebecca P. Hogan

rhogan@courts.state.va.us
Hon. Sharron S. Mitchell
smitchell@courts.state.va.us
Giles
Hon. Charles L. Fraley III

cfraley@courts.state.va.us
Gloucester
Hon. Margaret F. Walker
Goochland
Hon. Lee Grubbs Turner
Grayson
Hon. Susan M. Herrington
Greene
Hon. Marie C. Durrer
Greensville
Hon. Robert C. Wrenn
Halifax
Hon. Robert W. Conner
Hampton
Hon. Linda Batchelor Smith
Hanover
Hon. Frank D. Hargrove Jr.
Henrico
Hon. Yvonne G. Smith
Henry
Hon. Vickie Stone Helmstutler
275 South Main Street

Suite 212
Rocky Mount, VA 24151
P.O. Box 601 (Judge)
5 North Kent Street
Winchester, VA 22601
815 Princess Anne Street
P. O. Box 359
Fredericksburg, VA 224040359
P. O. Box 502
501 Wenonah Avenue
Pearisburg, VA 24134
7400 Justice Drive Room 327
Glouscester, VA 23061
P. O. Box 196
2938 River Road West
Goochland, VA 23063
P. O. Box 130
129 Davis Street
Independence, VA 243480130
P. O. Box 386
Standardsville, VA 229730386
22 Court Street
P. O. Box 631
Emporia, VA 23847-0631
P. O. Box 729
Main Street
Halifax, VA 24558-0729
P. O. Box 40
101 King's Way Mall
Hampton, VA 23669-0040
P.O. Box
7507 Library Dr.
Hanover, VA 23069
P.O. Box 90775
4301 East Parham Road
Henrico, VA 23273-0775
Fax:
540/483-3042
Tel:
540/667-5770
Fax: 540/667-6638
Tel:
540/372-1066
Fax: 540/310-0637
Judges Chambers:
540/372-1171
Judges Chambers Fax:
540/372-1174
Tel:
540/921-1722
Fax: 540/921-3825
Tel:
Fax:
Tel:
804/693-2502
804/693-2186
804/556-5353
Tel:
Fax:
276/773-2231
276/773-3338
Tel:
Fax:
434/985-5208
434/985-6723
Tel:
Fax:
434/348-4215
434/348-4020
Tel:
434/476-6211
Fax: 434/476-2890
Judges Office:
434/476-2890
Judges Fax:
434/476/6076
Tel:
757/727-6105
Fax: 757/728-3505
Tel:
Fax:
804/365-6150
804/365-6278
Tel:
804/501-4202
Suite B
Tel:
3160 Kings Mountain Rd.
Martinsville, VA 24112-3966
276/634-4880
Highland
Hopewell
Hon. Lois S. Ralston

lralston@courts.state.va.us
Hon. Tamara J. Ward
tward@courts.state.va.us
Isle of Wight
Hon. Sharon N. Jones
James City County/

Williamsburg
Hon. Betsy B. Woolridge
King and Queen
Hon. Deborah F. Longest
King George
Hon. Charles V. Mason
King William
Hon. Patricia M. Norman

pnorman@courts.state.va.us
Lancaster
Hon. Diane H. Mumford
Lee
Hon. Beverly R. Anderson

banderson@courts.state.va.us
Loudoun
Hon. Gary M. Clemens
Louisa
Hon. Susan R. Hopkins
Lunenberg
Hon. Gordon F. Erby
Lynchburg
Hon. Eugene C. Wingfield
Madison
Linda M. Parrish
Martinsville
Hon. Ashby R. Pritchett

APritchett@courts.state.va.us
P. O. Box 190
Monterey, VA 24465-0190
P. O. Box 310
100 E. Broadway
Room 251
Hopewell, VA 23860
17000 Josiah Parker Circle
P.O. Box 110
Isle of Wight, VA 23397
5201 Monticello Avenue
Suite Six
Williamsburg, VA 231888218
P. O. Box 67
Court House
King And Queen, VA 230850067
9483 Kings Highway Suite 3
King George, VA 224850105
351 Courthouse Lane
P. O. Box 216
King William, VA 230860216
P. O. Box 99
8265 Mary Ball Road
Lancaster, VA 22503
P. O. Box 326
Main Street
Jonesville, VA 24263-0326
P. O. Box 550
18 E. Market St.
Leesburg, VA 20178
Box 37
100 W. Main Street
Louisa, VA 23093-0037
Lunenburg, VA 23952
P. O. Box 4
900 Court Street
Lynchburg, VA 24505-0004
P. O. Box 220
1 Main Street
Madison, VA 22727-0220
Tel:
Fax:
Tel:
Fax:
540/468-2447
540/468-3447
804/541-2239
804/541-2438
Tel:
757/365-6233
Tel:
757/564-2242
Fax: 757/564-2329
Judges Chambers:
757/564-2300
Tel:
804/785-5984
Fax: 804/785-5698
Tel:
540/775-3322
Tel:
Fax:
Tel:
Fax:
804/769-4936
804/769-4937
804/769-4938
804/769-4991
804/462-5611
804/462-9978
Tel:
Fax:
276/346-7763
276/346-3440
Tel:
Fax:
703/777-0270
703/777-0376
Tel:
Fax:
540/967-5312
540/967-2705
Tel:
Fax:
Tel:
Fax:
434/696-2132
434/696-3931
434/455-2620
434/847-1864
Tel:
Fax:
540/948-6888
540/948-3759
P. O. Box 1206
Tel:
55 W. Church Street
Fax:
Martinsville, VA 24114-1206
276/656-5106
276/656-5232
Mathews
Hon E. E. Callis III
Mecklenburg
Hon. E. E. Coleman Jr.
Middlesex
Hon. Peggy W. Walton
Montgomery
Hon. Erica W. Williams
Nelson
Hon. Judy Stevens Smythers
New Kent
Hon. Karen A. Butler
Newport News
Hon. Rex A. Davis
Norfolk
Hon. George E. Schaefer
Northampton
Hon. Traci L. Johnson
Northumberland
Hon. Linda Booth

lbooth@courts.state.va.us
Nottoway
Hon. Jane L. Brown
Orange
Hon. Teresa T. Carroll
Page
Hon. C. R. Wilson
Patrick
Hon. Susan C. Gasperini
Petersburg
Hon. Benjamin O. Scott

BScott@courts.state.va.us
Pittsylvania
Hon. H. F. Haymore Jr.
P. O. Box 463
10622 Buckley Hall Road
Mathews, VA 23109
393 Washington Street
P. O. Box 530
Boydton, VA 23917-0530
P O Box 158
Routes 17 & 33
Courthouse
Saluda, VA 23149
1 E. Main Street, Suite B-5
Christiansburg, VA 240686309
P. O. Box 10
84 Courthouse Square, 1st
Floor
Lovingston, VA 22949-0010
P. O. Box 98
Courthouse
12001 Courthouse Circle
New Kent, VA 23124-0098
2500 Washington Avenue
Courthouse Building
Newport News, VA 23607
100 St. Paul's Boulevard
Norfolk, VA 23510
P.O. Box 36
5229 The Hornes
Eastville, VA 23347-0036
P. O. Box 217
39 Judicial Place
Heathsville, VA 22473-0217
328 West Courthouse Road
Nottoway, VA 23955-0025
110 North Madison Rd Suite
300
P. O. Box 230
Orange, VA 22960
116 South Court Street
Suite A
Luray, VA 22835
P. O. Box 148
101 Blue Ridge Street
Stuart, VA 24171-0148
7 Courthouse Avenue
Petersburg, VA 23803
Tel:
Drawer 31
3 N. Main Street
Chatham, VA 24531
804/725-2550
Tel:
434/738-6191
Ext. 298
Fax: 434/738-6861
Tel:
804/758-5317
Fax: 804/758-8637
Tel:
Fax:
540/382-5760
540/382-6937
Tel:
Fax:
434/263-7020
434/263-7027
Tel:
Fax:
804/966-9520
804/966-9528
Tel:
Fax:
757/926-8561
757/926-8531
Tel:
757/664-4580
Tel:
Fax:
757/678-0465
757/678-5410
Tel:
Fax:
804/580-3700
804/580-2261
Tel:
Fax:
Tel:
Fax:
434/645-9043
434/645-2201
540/672-4030
540/672-2939
Tel:
Fax:
Tel:
Fax:
540/743-4064
540/743-6902
540/743-2338
540/694-7213
540/694-6943
Tel:
Fax:
804/733-2367
804/732-5548
Tel:
Fax:
434/432-7887
434/432-7913
Portsmouth
Hon. Cynthia P. Morrison

CMorrison@courts.state.va.us
Powhatan
Hon. William E. Maxey Jr.

wmaxey@courts.state.va.us
Prince Edward
hon. Machelle J. Eppes

meppes@coruts.state.va.us
Prince George
Hon. Bishop Knott Jr.
Prince William
Hon. Michele B. McQuigg

mmcquigg@pwcgov.org
Pulaski
Hon. Maetta H. Crewe
Radford
Rappanhannock
Hon. Ann Howard

ahoward@radford.va.us
Diane Bruce
Richmond
Hon. Bevill M. Dean
Richmond County
Hon. Rosa S. Forrester
Richmond Manchester Bevill M. Dean
Roanoke City
Hon. Brenda S. Hamilton

circlek@ci.roanoke.va.us
Roanoke County
Hon. Steven A. McGraw, Sr.

smcgraw@roanokecountyva.gov
Rockbridge
Hon. D. Bruce Patterson

dbpatterson@courts.state.va.us
P. O. Box 1217
601 Crawford Parkway
Portsmouth, VA 23705-1217
P. O. Box 37
3880 Old Buckingham Road
Suite C
Powhatan, VA 23139-0037
Courthouse Building
P. O. Box 304
North Main Street
Farmville, VA 23901-0304
P. O. Box 98
6601 Courts Drive
Prince George, VA 238750098
Judges: P.O. Box 280
9311 Lee Avenue
Manassas, VA 20110
45 Third Street, NW
Suite 101
Pulaski, VA 24301
619 Second Street, West
Radford, VA 24141
238 Gay Street
P. O. Box 517
Washington, VA 22747-0517
Tel:
757/393-8671
Tel:
Fax:
804/598-5660
804/598-5608
Tel:
Fax:
434/392-5145
434/392-3913
Tel:
804/733-2640
Fax: 804/861-5721
Court Administrator:
804/733-2623
Tel:
703/792-6015
Criminal Fax:
703/792-4721
Civil Fax:
703/792-7750
Tel:
540/980-7825
Fax: 540/980/7835
Tel:
540/731-3610
Fax: 540/731-3612
Tel : 540/675-5350
Fax: 540/675-5351
400 North Ninth Street

Tel:
John Marshall Courts Building Fax:
Richmond, VA 23219
P. O. Box 1000
101 Court Circle
Warsaw, VA 22572-0956
10th & Hull Streets
Manchester Courthouse
Richmond, VA 23224-0129
P.O. Box 2610
315 Church Avenue, S.W.
Roanoke, VA 24016
305 East Main Street, Room
200
P. O. Box 1126
Salem, Virginia 24153-1126
Rockbridge County
Courthouse
20 South Randolph St Suite
804/646-6505
804/646-6562
Tel:
Fax:
804/333-3781
804/333-5396
Tel:
Fax:
804/646-8470
804/646-8122
Tel:
Fax:
540/853-6702
540/853-1024
Tel:
Fax:
540/387-6205
540/387-6145
Tel:
Fax:
540/463-2232
540/463-3850
Rockingham
Russell
Salem
101
Lexington, VA 24450
Hon. Chaz W. Evans-Haywood
Rockingham County
clerkchaz@rockinghamcountyva.g Courthouse
ov
Court Square
Harrisonburg, VA 22801
Hon. Ann Sword McReynolds
P. O. Box 435
Main Street
Lebanon, VA 24266-0435
Hon. Chance Crawford
2 East Calhoun Street
CCrawford@courts.state.va.us
Salem, VA 24153
Tel:
Fax:
540/564-3111
540/564-3127
Tel:
Fax:
276/889-8023
276/889-8003
Tel:
Fax:
540/375-3067
540/375-4039
Scott
Hon. Mark A. (Bo) Taylor
Shenandoah
Hon. Denise F. Barb
Smyth
Hon. John H. Graham
Southampton
Hon. Richard L. Francis

rfrancis@courts.state.va
Spotsylvania
Hon. Christalyn M. Jett
Stafford
Hon. Barbara G. Decatur

BDecatur@courts.state.va.us
Staunton
Hon. Thomas E. Roberts
Suffolk
Hon. W.R. Carter Jr.
Surry
Hon. Gail P. Clayton

gclayton@courts.state.va.us
Sussex
Hon. Gary M. Williams
Tazewell
Hon. James E. Blevins

bblevins@courts.state.va.us
Hon. Tina E. Sinnen
TSinnen@courts.state.va.us
202 West Jackson St Suite102 Tel:

276/386-3801
Gate City, VA 24251
Fax: 276/386-2430
P.O. Box 406
Tel:
(540) 459-6150
Fax: (540) 459-6155
Woodstock, Virginia 22664
109 W. Main Street Room 144 Tel:
276/782-4044
Marion, VA 24354-1025
Fax: 276/782-4045
P. O. Box 190
Tel:
757/653-2200
22350 Main Street
Courtland, VA 23837
P. O. Box 96
Tel:
540/582-7600
Fax: 540/582-2169
Spotsylvania, VA 22553-0096
P.O. Box 69
Tel:
540-658-8750
1300 Courthouse Road,
Fax:
Stafford, VA 22555
113 E. Beverley Street
Tel:
540/332-3874
Staunton, VA 24402-1286
Fax: 540/332-3970
P. O. Box 1604
Tel:
757/514-7800
Mills E. Godwin, Jr. Courts Fax: 757/514-7103
Bldg.
150 North Main Street
Suffolk, VA 23439-1604
28 Colonial Trail East
Tel:
757/294-3161
Routes 10 And 31
Fax: 757/294-0471
Surry, VA 23883-0203
P. O. Box 1337
Tel:
434/246-5511
434/246-1012
Route 735
Fax: 434/246-2203
Sussex, VA 23884
101 Main Street
Tel:
276/988-1222
Tazewell, VA 24651-0968
Fax: 276/988-7501
2425 Nimmo Parkway
Tel:
757/427-4187
Virginia Beach, VA 23456
Fax: 757/426-5686
Hon. Jennifer R. Sims

jsims@courts.state.va.us
Hon. Patricia S. Moore
1 East Main Street

Front Royal, VA 22630
189 East Main Street
Virginia Beach
Warren
Washington
Tel:
Fax:
Tel:
540/635-2435
540/636-3274
276/676-6224
Abingdon, VA 24212-0289
Waynesboro
Hon. Nicole A. Briggs

briggsna@ci.waynesboro.va.us
250 South Wayne Avenue

P.O. Box 910
Waynesboro, VA 22980-0910
Westmoreland
Hon. Gwynne J. Chatham
Williamsburg James
City County
Hon. Betsy B. Woolridge
Winchester
Hon. Terry H. Whittle

twhittle@courts.state.va.us
Hon. J. Jack Kennedy
jack@jackkennedy.net
P. O. Box 307
Courthouse
Montross, VA 22520-0307
5201 Monticello Avenue
Suite Six
Williamsburg, VA 231888218
5 North Kent Street
Winchester, Virginia 22601
P.O. Box 1248
206 E. Main Street, Court
House
Wise, Virginia 24293-1248
Circuit Court Building
225 S. Fourth Street
Room 105
Wytheville, VA 24382
300 Ballard Street
P.O. Box 371
Yorktown, Virginia 23690
Wise
Wythe
Hon. Hayden H. Horney

HHorney@courts.state.va.us
York
Hon. Lynn S. Mendibur
Fax:
Tel:
Fax:
276/676-6226
276/676-6218
540/942-6616
540/942-6774
Tel:
Fax:
804/493-0108
804/493-0393
Tel:
Fax:
757/564-2242
757/564-2329
Tel:
Fax:
Tel:
Fax:
540/667-5770
540/667-6638
276/328-6111
276/328-0039
Tel:
Fax:
276/223-6050
276/223-6057
Tel:
Fax:
757/890-3350
757/890-3364
APPENDIX F
Approval of the Right to Be Eligible to Register to Vote2
Source: http://www.courts.state.va.us/courts/circuit/resources/manuals/cc_manual_civil/chapter_06.pdf
Additional information can be found at: http://www.courts.state.va.us/forms/circuit/cc1402.pdf.
A petition filed by a convicted felon seeking court approval of the restoration of the right to be eligible to register to
vote. This procedure applies only to the right to vote, not to the other civil rights which are lost upon conviction of a
felony. A person must seek restoration of those rights directly by the Governor, through an application filed with the
Secretary of the Commonwealth.
Procedures:
Step 1: Petition is filed with the clerk of the Circuit Court. Petitions are filed in the county of city in which the
Petitioner resides or in the county or city in which the individual was convicted.
Typical documents filed with the petition would include:
o Criminal history;
o Letter from Probation Officer outlining period of supervision;
o Letters of reference; and
o Proof of civic responsibility
A Word version is provided below but it can also be found at: http://www.courts.state.va.us/forms/circuit/cc1403.pdf.
Step 2: The clerk receipts for filing fee (unless court approves proceeding in forma pauperis), opens a new case file
and dockets the case. The cost of filing is approximately $10. You may confirm at the Circuit Court Fee Calculator:
http://webdev.courts.state.va.us/cgi-bin/DJIT/ef_djs_ccfees_calc.cgi#ID_CALC_FRM.
Step 3: Hearing held.
Step 4: Order entered approving or denying petition. If petition is approved, the order must state that the petitioner's
right to be eligible to register to vote may be restored by the date that is ninety days after the date of the court order,
subject to the approval or denial of the Governor.
Step 5: Clerk provides copy of Approval or Denial Order to the petitioner and sends (fax) a copy to the Secretary of
the Commonwealth. (The Secretary of the Commonwealth requests that all documents filed relating to the petition be
forwarded with the copy of the court's order.)
The Secretary of the Commonwealth shall transmit the order to the Governor for approval or denial. The Secretary of
the Commonwealth shall send, within ninety days of the date of the court order, to the petitioner at the address stated
on the court's order, a certificate of restoration of that right or notice that the
Governor has denied the restoration of that right.
Appeal from the denial of restoration from Circuit Court would be to the Supreme Court. There is no right of appeal
upon a denial from the Governor.
Please note that this appendix was edited for formatting, clarity, and relevant substance for the ROR Guide. For the original
material, please check the indicated source.
PETITION FOR APPROVAL OF THE RIGHT TO BE ELIGIBLE TO REGISTER TO VOTE

COMMONWEALTH OF VIRGINIA
Case No. ..............................................................................
To the Circuit Court of
I, .............................................................................. , hereby petition this court for approval of this petition seeking
NAME OF PETITIONER
restoration of my eligibility to register to vote. In support of this petition, I state that the following information is true:
1.
My current address and telephone number are:

........................................................................................................................................................................................
ADDRESS
................................................................................
TELEPHONE NUMBER
2.
The felony conviction(s) which led to the loss of my civil rights was (were):
..........................................................................................................................................................................................................
NAME AND CODE SECTION OF VIOLATIONS
for which I was convicted on

...............................................................................in.................................................................. ..............................................................
DATE
COURT
[ ] ATTACHED ADDITIONAL SHEET(S)
3. As a result of the conviction(s), I received a sentence of, .........................................................................., of which
..........................................................................was suspended.
[ ] I was placed on probation for .......................................................................................................................................
4. I am not currently on probation or parole, nor am I subject to any suspended sentence.
5. At least five years have passed since the completion of any sentence and any modification of sentence, including all periods of
probation or parole and any suspension of sentence.
6. I have not been convicted of any criminal violation during the period set out in paragraph 5 above. I understand that this
affirmation does not include convictions for traffic infractions.
7. I have demonstrated civic responsibility through the following community or comparable service:
....................................................................................................................................................................... ...........................................
..................................................................................................................................................................................................................
.............................................................................................................................................................................................................
[ ] ATTACHED ADDITIONAL SHEET(S)
In support of this petition, the following documents are attached:
......................................................................................................................................................... ....................................................
.............................................................................................................................................................................................................
.............................................................................................................................................................................................................
Based on the above, I petition this Court under Virginia Code 53.1-231.2 for approval of my eligibility to register to vote.
............................................
DATE
..............................................................................
SIGNATURE OF PETITIONER
FORM CC-1403
APPENDIX G
Notary Public Information
Source: http://www.nationalnotary.org/resources_for_notaries/what_is_a_notary/index.html
A Notary Public is an official of integrity appointed by state governmenttypically by the secretary of state to
serve the public as an impartial witness in performing a variety of official fraud-deterrent acts related to the signing of
important documents. These official acts are called notarizations or notarial acts. Notaries are publicly commissioned
as ministerial officials, meaning that they are expected to follow written rules without the exercise of significant
personal discretion, as would be the case with a judicial official.
Impartiality is the byword of the Notary office and the foundation of its public trust. Notaries are duty-bound not to act
in situations where they have a personal interest. The public trusts that the Notarys critical screening tasks have not
been corrupted by self-interest. And impartiality dictates that a Notary never refuses to serve a person due to race,
nationality, religion, politics, sexual orientation or status as a non-customer.
Common Places to Find a Notary Public:
Banks
County or City Government Office
County District or Circuit Court
Public School
Public Library
Online directory at http://www.notarypublic.com/.
Cost for a Notarial Act:

Effective July 1, 2007, a notary public cannot charge more than $5.00 under Virginia law for most notarial acts.
http://www.dmbe.virginia.gov/pdf/Notary%20HB2058%20Notice20007.pdf
APPENDIX H
Obtaining a Virginia Identification Card3
Source: http://www.dmv.state.va.us/webdoc/citizen/id/get_id.asp
Note: As of April 21, 2010, the sheriff, jail superintendent, or other jail administrator may issue a government-issued
identification card to any prisoner who does not already have an ID. This is known as a special jailer issued
identification card. The prisoner must still pay all costs for the card. Va. Code 53.1-116.1:02.
If you do not have a drivers license or any other state-issued identification, you may apply for an identification card:
Has no age restriction.

Is available for an adult or child who does not already hold a learner's permit or driver's license issued
from a state within the United States.
ID cards expire at the end of the month in which you were born when you reach an age divisible by five; (e.g.
20, 25, 30 etc.)
Individuals required to register with the Virginia State Police Sex Offender and Crimes Against Children registry
(Virginia Code Chapter 9 of Title 9.1) will be issued ID cards valid for five years.
If you are authorized to be in the U.S. temporarily, you will be issued an ID card valid only for the amount of time
that you are legally permitted to stay in the U.S. You will not be eligible to receive a limited duration ID card if your
authorized stay in the U.S. is less than 30 days from the date of your application. The expiration of the ID card will be
the same as the expiration date shown on the document used to prove legal presence. If the document does not show an
expiration date, the ID card will be valid for one year.
You may exchange your valid Virginia driver's license for an ID card for a $10.00 fee. If you are age 70 or older and
have not previously held an ID card, there is no charge for exchanging your license for an ID card. You will be
charged the $10.00 fee if you are 70 or older and have previously held an ID card.
Required Documents
If you are applying for an ID card for the first time and do not hold a valid Virginia driver's license, each time you
apply for the ID card, you will be required to show two proofs of identity (only one primary document if you are
under age 19), one proof of legal presence and one proof of Virginia residency. You will be required to show these
required documents on each return visit until your ID card is issued.
Your proof of legal presence must contain your full legal name and date of birth (birth certificate, unexpired
passport, unexpired employment authorization document (USCIS form I-766), resident alien card, etc.)
Your proof of Virginia residency may include a U.S. marriage certificate, military ID card or discharge papers,
social security card, certified copy of school records, department of corrections offender information report,
department of education certificate of enrollment form (USCIS form I-797), etc.
For a complete list, visit http://www.dmv.state.va.us/webdoc/pdf/dmv141.pdf.
If you were born in 1937 or earlier and you want to apply for an ID card, you will not have to provide proof of legal
presence if you now hold or previously held a Virginia driver's license or ID card, provided your license or ID card has
not been expired for more than 5 years and DMV can verify that it was issued to you. If you do not still have the
license or ID card when you apply for your new ID card, be prepared to provide alternative proof that you held the old
license or ID card. DMV will attempt to verify your old license or ID card if you cannot provide any alternative proof.
3
Please note that this appendix was edited for formatting, clarity, and relevant substance for the ROR Guide. For the original
material, please check the indicated source.
However, if DMV cannot verify its issuance, or you are authorized to be in the U.S. temporarily, you will be required
to present one document as proof of legal presence to obtain your new ID card.
All documents must be originals. Falsifying information on any driver's license or identification card application is a
criminal offense.
DMV will assign you a customer number which will display on your ID card. If you wish to change your DMVassigned number in the future, you may be required to present documentation from law enforcement or the courts
indicating that you may be a victim of identity theft.
Selective Service Registration
Generally males under age 26 must register with the Selective Service. If you are required by federal law to register
with the Selective Service, you must authorize DMV to forward your personal information to the Selective Service
unless you have already registered.
If you are under age 18, your parent or guardian must sign your application authorizing the Selective Service to
register you when you turn age 18. Law prohibits DMV from issuing any type of driver's license or ID card to an
applicant who is required by federal law to register with the Selective Service but who refuses to authorize DMV to
send his information to the Selective Service. If you have questions about Selective Service registration, visit the
Selective Service website at www.sss.gov or call 847-688-6888 (TTY: 847-688-2567).
Completing the Application
When applying for an ID card or a hearing-impaired ID card, you must complete a Driver's License, Identification
Card, and Voter Registration Application (form DL 1P).
Payment
An ID card costs $10.00. You may pay your fees with cash, money order, check, check card or major credit card.
Issuance
You will receive your newly designed secure ID card in the mail. DMV has converted to a new secure process for
issuing driver's licenses and ID cards and has discontinued issuing them over the counter. The new secure process is
similar to the U. S. passport process and reduces the risks of fraud.
If you have renewed your ID card, you can continue to carry your old ID card with your receipt until you receive your
new ID card in the mail.
Make sure DMV has your current, correct address on record, as your license will be mailed to the address in DMV's
records. Notify DMV right away if you have moved. The U.S. Postal Service will not forward driver's licenses.
APPENDIX I
Instructions for Requesting a Copy of Your Birth Certificate4
Office of Vital Records Request for Birth Certificate
P.O. Box 1000
General Information Number: 804-662-6200
We encourage you to mail your letter request to our office. We require 1) a signed letter 2) legible identification
documentation (which may include a Virginia Criminal Justice Agency Offender Information Form, United States
Probation Offender Information Form) and 3) payment before we can process your order.
Please include the information below and payment in your SIGNED letter:
Name at birth
Date of birth
Place of birth
Mother's Maiden name
Father's name
Relationship to the person on the certificate
Reason for the certificate
Area code + daytime phone
number
Return address
Virginia statutes require a fee of $12.00 be charged each certification of a vital check record or for a search of the files
when no certification is made. Please make check or money order payable to the State Health Department.
Check and Money Orders are the only accepted method of payment. Please remember to sign the check or money
order.
Please allow delivery time of 2 to 4 weeks from the date the request is received in this office.
Individuals Who Need to Correct Their Gender on a Birth Certificate:
The process to change a gender marker on official documents, such as birth certificates, varies from state-to-state.
While Virginias process is clear in terms of procedure, it is less clear in terms of standards for judging who may
receive an order, and therefore, may request a new birth certificate. Most courts will require some kind of sex
reassignment surgery; however, other procedures have been considered sufficient. The basic procedure is as follows:
Step 1: File a petition (sample below) with the Circuit Court in which you reside requesting a gender change, attaching
a physicians letter (indicating a GID diagnosis, hormone therapy, surgery/ies), previous name change order (if you
had one; sample below; also available at http://www.courts.state.va.us/forms/circuit/cc1411.pdf), and filing fee
(approximately $40).
Step 2: If the Circuit Court approves the petition, it will issue an order. Then, you must submit the order (along with a
name change order, if you have one) to the Vital Records of the state in which you were born. Next, you should
receive a corrected birth certificate. Va. Code Ann. 32.1-269(E) (2006).
Please note that this appendix, except the name change form below, was edited for formatting, clarity, and relevant substance for
the ROR Guide. For the original material, please check the indicated source.
Step 3: After receiving your corrected birth certificate, you should submit these documents to the nearest Social
Security office to receive a new card. From there, you can take the gender change order and new Social Security card
to the DMV to obtain an ID.
Note: A court order may not be necessary if, as a person born in Virginia, you submit acceptable evidence (GID
diagnosis, description of any surgical procedure, etc.) and notarized note from your physician directly to the Vital
Records Office. 12 Va. Admin. Code 5-550-320 (2006).
For additional information, contact Advancement Projects Voter Protection Program, at 1-855-LET-VOTE.
APPLICATION FOR CHANGE OF NAME (ADULT)

VIRGINIA: In the Circuit Court of the [ ] City [ ] County of ..............................................................................
IN RE: ............................................................................................................................................................
(APPLICANTS NAME) FIRST MIDDLE LAST SUFFIX
COMES NOW, the applicant, ...................................................................................................................
and after being duly sworn states under oath as follows:
1. Applicants Birth Name: ................................................................................................................................
FIRST MIDDLE LAST SUFFIX
2. Residence Address: ......................................................................................................................................
STREET ADDRESS
..................................................................................................................................................................
CITY STATE ZIP CODE COUNTRY
3. Mailing Address: .........................................................................................................................................
IF DIFFERENT FROM RESIDENCE ADDRESS
4.
Date of Birth: ........................................................ Place of Birth:...........................................................
5. Fathers Full Name: ......................................................................................................................................

6. Mothers Full Name: .....................................................................................................................................
FIRST MIDDLE MAIDEN CURRENT LAST
Answer the following questions by checking appropriate Yes or No box and providing
information as requested.
1. Have you ever been convicted of a felony?...............................................................................[ ] Yes [ ] No
2. Are you currently incarcerated? ** ........................................................................................[ ] Yes [ ] No
If yes, indicate facility name: ........................................................................................................................
3.
Facility Location:........................................................................................................................................
4. Are you a probationer with any court?** .................................................................................[ ] Yes [ ] No
If yes, indicate court name: ...........................................................................................................................
5. Have you previously changed your name either by a prior application or by marriage?......................
[ ] Yes [ ] No
(If yes, attach court order or other documentation and indicate previous names):
..................................................................................................................................................................
** Applications of probationers and incarcerated persons MAY be accepted if the Court finds good cause
exists for such application. Attach explanatory documentation to the application.
FORM CC-1411 (MASTER, PAGE ONE OF TWO) 05/08 Va. Code 8.01-217
WHEREFORE, the undersigned applicant further certifies under oath that this name change is not sought for any
fraudulent purposes and will not infringe upon the rights of others, and pursuant to 8.01-217 of the Code of Virginia,
1950, as amended, the applicant requests that the Court order a change of name from:
........................................................................................................................................................................
to
........................................................................................................................................................................
______________________________________________________________
APPLICANT
Commonwealth/State of ..............................................................
[ ] City [ ] County of ........................................................
Subscribed and sworn to/affirmed before me this .................. day of ................................................., 20 ..................
by ...................................................................................................................................................................
...............................................................................................................................................................................................
[ ] CLERK [ ] DEPUTY CLERK
[ ] NOTARY PUBLIC My commission expires ............................ Registration No. ............................
FORM CC-1411 (MASTER, PAGE TWO OF TWO) 05/08 Va. Code 8.01-217
VIRGINIA: IN THE CIRCUIT COURT OF THE _____________________(county or city) OF

_____________________ (name of county of city)
IN RE: (full name)s Change of Gender Status
CASE NO #___________________________
PETITION FOR CHANGE OF GENDER STATUS TO THE HONORABLE JUDGES OF THE
AFOREMENTIONED COURT:
Comes now, _____________________ (full name), (_____________________) (social security number in
parentheses), petitions this Honorable Court to change _____________________ (her or his depending on how you
currently identify) gender status to (male or female) and as grounds therefore respectfully represents as follows:
1. That your Petitioner resides in _____________________ (city, county, town) Virginia;
2. That the Petitioners father is _____________________ and mother _____________________ (full legal name),
and the mothers maiden name is _____________________.
3. That _____________________(full name) was born on _____________________ (date) in the
_____________________ (county or city) of _____________________ (name of county or city).
4. That _____________ (she/he) did, on the _____________________ (surgery or procedure), in
_____________________ (city and state where surgery or procedure was performed) under the care of
_____________________ (surgeon or physician full name), successfully undergone _____________________ (name
of procedure).
5. That _____________________ (she/he) desires to correct _____________________ (her/his) record to reflect the
correct gender status;
6. That _____________________ (she/he) requests the Court to change _____________________ (her/his) gender
status to that of male as evidenced by the enclosed affidavit and his signature on this petition.
WHEREFORE, your petitioner prays this honorable Court to change his sex designation to male and to this end all
necessary and proper orders be entered pursuant to Section 32. 1-269 of the Code of Virginia, as amended.
I Ask For This:
_________________________________________
(Full name)
(Address)
(Phone number)
1220 L Street NW
Suite 850
Washington, DC 20005
(202) 728-9557

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VIRGINIA CIVIL RIGHTS

Short application for non-violent offenses;

Petition to the court for non-violent offenses.

Part 1: Frequently Asked Questions about VAs Rights Restoration Process

3. Should I complete an application or petition the court?

Part 2: Short Application for Non-Violent Convictions

Was conviction for a felony offense?

Was the conviction for a felony offense?

Was the conviction for a non-violent offense?

Have all court costs, fines and restitution been paid?

Was conviction for a felony offense?

Was conviction for a felony offense?

Have all court costs, fines, and restitution been paid?

Part 4: Petition to Court for Non-Violent Offenses

Was the felony conviction for a non-violent offense?

Was conviction for a felony offense?

Was conviction for a non-violent offense?

Have you demonstrated civic responsibility through community or comparable service?

ADVANCEMENT PROJECT VIRGINIA CIVIL RIGHTS

Restoration of Civil Rights

Not have any misdemeanor and/or

Application for Restoration of Rights for Certain Nonviolent

Restoration of Civil Rights

Your employer or job supervisor;

Mail your application to:

application, completely filled out, signed and notarized

copies of all felony sentencing orders

proof of payment for any fines, restitution and/or court costs

letter of petition, signed and dated

Felony Offense(s): _________________________________________________________________

Date(s) of Conviction: __________________________ Date(s) of Sentence: __________________________

1. If you were on supervised probation or parole:

Mail this application and all required documentation to:

I hope this information will be helpful to you.

I hope this information will be helpful to you.

I hope this information will be helpful to you.

Drug Possession with the Intent to Distribute

Class 4 felony obstructing or injuring canal, railroad, power line, etc.

Prisoner escaping from jail

Hon. Debra Shipp

Edward Semonian Jr.

Hon. Debra Byer

Hon. Marilyn Wilson

Hon. Roy C. Mayo III

Hon. Janet A. Robertson

Hon. Paul F. Ferguson

Hon. John B. Davis

Hon. M. Wayne Winebriner

Hon. Cathy C. Hogan

Hon. Rebecca I. Johnson

Information obtained from www.courts.state.va.us/courts/courts.html.

Hon. Tommy L. Moore

Hon. Terry G. Rohr

Hon. V. Earl Stanley Jr.

Hon. Beverly S. Tiller

Hon. Malcolm Booker Jr.

Hon. Christopher W. Coleman

Hon. Sheila Bosiger

Hon. Ray S. Campbell Jr.

Hon. Carolyn H. Honeycutt

Hon. Edith K. Holmes

Hon. Stuart B. Fallen

Date(s) of Conviction: Date(s) of Sentence: