Here is what I use. The judges always ask for it, but never coment one way or the other. I am assuming it is good for all VA courts. You will have to check the spelling yourself.
NOTICE TO PAY RENT OR QUIT
TO: (Tenants name and address)
Notice to you and all others in possession of the below premises, that you are herby notified to vacate, quit and deliver up the premesis you hold as our tenant, namely:
(address of rental)
You are to deliver up said premises within 5 days of receipt of the notice, pursuant to applicable state law. This notice is provided due to non-payment of rent. The present rent arrearage is in the amount of S(amount owed) based on the following account:
(detailed outline of how you reached the balance owed)
You may reinstate your tenancy by full payment of said arrears within 5 days as provided under the terms of your tenancy by applicable stae law. In the event you fail to bring your rent payment/balance due current of vacate the premises, we shall immediately take legal action to evict you and to recover rents and damages for the unlawful detention of said premises together with such future rents as may be due us for breach of your tenancy aggreement.
Signed (your name and address)
Proof of Service
I, the undersigned being at least eighteen years of age, declare under penalty of perjury that I served the within notice to pay rent or quit tenany of which this is a true copy on the above named tenant in the manner indicated below on (date you mailed out)
__I personally delivered a copy of the notice to tenant
__I mailed a true copy of the notice to tenant by certified mail
__I mailed a true copy of this notice to tenant by first-class mail (I use this)
Excuted on (Date)