12 Va. Admin. Code § 5-550-140
The report of divorce or annulment to be used shall be the Report of Divorce or Annulment, Commonwealth of Virginia, and shall contain the following items: city or county of court of issuance; for the husband: full name, date and place of birth, social security number or control number issued by the Department of Motor Vehicles, education, number of marriage, usual residence; for the wife: full maiden name, date and place of birth, social security number or control number issued by the Department of Motor Vehicles, education, number of the marriage, usual residence; date and place of marriage; identity of plaintiff and to whom divorce granted; number and custody of children under 18 in this family; date of separation; date of divorce; legal grounds or cause of divorce; signature of attorney or petitioner; certification and signature of clerk of court indicating type of decree; court file number; date final order entered; and state file number.
12 Va. Admin. Code § 5-550-140
Statutory Authority
§§ 32.1-12 and 32.1-250 of the Code of Virginia.