Va. Code § 8.01-241.1
Any extension of the limitations of the right to enforce the lien of a deed of trust or mortgage shall conform substantially with the following form:
CERTIFICATE OF EXTENSION OF LIMITATION OF
RIGHT TO ENFORCE DEED OF TRUST OR MORTGAGE
Place of Record...........................................................
Date of Deed of Trust/Mortgage...........................................
Deed Book.............. Book Page....................................
Name of Guarantor(s)......................................................
Name of Trustee(s)........................................................
Maker(s) of Note..........................................................
Date of Note(s)...........................................................
I/we, the beneficial title holder(s) of the property encumbered by the above mentioned deed of trust/mortgage, do hereby certify that the lien of the same is hereby extended 10 years from the date of my/our endorsement upon this certificate.
...........................................................
Beneficial Titleholder/Attorney-in-Fact/Agent
Commonwealth of Virginia
County/City of................:
Subscribed, sworn to and acknowledged before me by
..........., this day of........, 20
My Commission expires:................
Notary Public
Va. Code § 8.01-241.1