1. Name of locality and check box for appropriate court. 2. Address of court. 3.The approval is in the form of a Withdrawal of the Notice of Hearing and Approval of Request for Withdrawal of Petition (see FLRA. Once the hearing has been held, the hearing officer sends the. Administrative Hearing Decision (out of state) form to the parties. b. How to Fill Out Revisable PDF Forms. You may receive the form, Judgment Debtor Information Sheet (CC-DC-CV-114) from the judgment creditor. Please note: This form is to be completed only after a customer has received a judgment from a SWBNO hearing officer. Original – to court. b. First copy – to debtor for notice as required in Va. Code § 8.01-433. 2.