Utah District Court Cover Sheet for All Civil Actions Except Probate Cases Civil Cover Sheet Revised September 26, 2018 Page 1 Interpretation. If you do not speak or understand English, contact the court at least 3 days before the hearing or mediation, and an interpreter will be provided. Interpretaci363n. Si usted no habla o entiende el Ingl351s contacte al tribunal por lo menos 3 d355as antes de la audiencia o mediaci363n y le proveer341n un int351rprete. Plaintiff/Petitioner (First) Name Address City, State, Zip Phone Email First Plaintiff/Petitioner222s Attorney* Name Bar Number ---------------------------------------------------------------------------------- Plaintiff/Petitioner (Second) Name Address City, State, Zip Phone Email Second Plaintiff/Petitioner222s Attorney* Name Bar Number Defendant/Respondent (First) Name Address City, State, Zip Phone First Defendant/Respondent222s Attorney* Name Bar Number ---------------------------------------------------------------------------- Defendant/Respondent (Second) Name Address City, State, Zip Phone Second Defendant/Respondent222s Attorney* Name Bar Number *Attorney mailing and email addresses provided by Utah State Bar. Total Claim for Damages $ Jury Demand Yes No $250 Jury Demand Schedule of Fees: 24778a-2-301 (Choose all that apply. See Page 2 for fees for claims other than claims for damages.) PLEASE CHOOSE ONE : No m onetary d amages are r equested (URCP 26: Tier 2) Damages requested are $50,000 or less (URCP 26: Tier 1) Damages requested are more than $50,000 and less than $300,000 (URCP 26: Tier 2) Damages requested are $300,000 or more (URCP 26: Tier 3) D amages are un specified . Circle one : Tier 1 Tier 2 Tier 3 This case is exempt from URCP 2 6 . (E) 227 227 MOTION TO RENEW JUDGMENT 227 227 $37.50 Damages $2000 or less $92.50 Damages $2001 - $9,999 $180 Damages $10,000 & over 227 227 COMPLAINT OR INTERPLEADER 227 227 $75 Damages $2000 or less $185 Damages $2001 - $9999 $360 Damages $10,000 & over $360 Damages Unspecified 227 227 C OUNTERCLAIM, CROSS CLAIM, THIRD PARTY CLAIM, OR INTERVENTION 227 227 $55 Damages $2000 or less $150 Damages $2001 - $9999 $155 Damages $10,000 & over American LegalNet, Inc. www.FormsWorkFlow.com Civil Cover Sheet Revised September 26 , 2018 Page 2 Choose One Fee Case Type 227 227 227 227 227 APPEALS 227 227 227 227 227 $360 Administrative Agency Review Sch Tax Court (Appeal of Tax Commission Decision) Court: Refer to Clerk of Court upon filing. $225 Civil (78A - 2 - 301(1)(h)) (E) $225 Small Claims Trial De N ovo (E) 227 227 227 227 GENERAL CIVIL 227 227 227 227 Sch Civil Rights $0 Civil Stalking (E) $360 Condemnation/Eminent Domain Sch Contract s Sch Contract: Employment Discrimination Sch Contract: Fraud Sch Debt Collection $360 Essential Treatment Intervention (62A - 15 - 1203) Sch Eviction/Forcible Entry and Detainer (E) $360 Extraordinary Relief/Writs $360 Forfeiture of Property (E) Sch Interpleader Sch Lien/Mortgage Foreclosure Sch Miscellaneous Civil $360 Post Conviction Relief: Capital (E) $360 Post Conviction Relief: Non - capital (E) Sch Property Rights $360 Registry Removal (Gun/White Collar) Sch Sexual Harassment Sch Water Rights $360 Wrongful Lien Sch Wrongful Termination 227 227 227 227 227 227 227 TORTS 227 227 227 227227 227 227 Sch Automobile Tort Sch Intentional Tort Sch Malpractice - Medical Tort Sch Malpractice - Legal Tort; Other Sch Premises Liability Sch Asbestos Sch Product Liability (NOT Asbestos) Sch Slander/Libel/Defamation 227 227 227 227 DOMESTIC RELATIONS 227 227 227 227 $0 Protective Orders (E) Marriage Adjudication (T2) $310 Custody/Visitation/Support (T2) $310 Divorce/Annulment (T2) $310 Check if child support, custody or parent - time will be part of decree Check if Temporary Separation filed Vi tal Statistics 24726 - 2 - 25 per form Fee Case Type $8 Counterclaim : Divorce/Sep Maint . $115 Counterclaim: Custody/Visit / Support $ 115 Counterclaim: Paternity/Grandparent Visitation $155 Domestic Modification (T2) $100 Counter - petition: Domestic Mod. $100 Grandparent Visitation (T2) $360 Paternity/Parentage (T2) $360 Separate Maintenance (T2) $310 Temporary Separation (E) $35 Uniform Child Custody Jurisdiction & Enforcement Act (UCCJEA) ( E) $35 Uniform Interstate Family Support Act (UIFSA) ( E) $35 Uniform Interstate Family Support Act (UIFSA) ( E) 227 227 227 227 227 JUDGMENTS 227 227 227 227 227 $35 Foreign Judgment ( Abstract of ) (E) $50 Abstract of Judgment/Order of Utah Court/Agency ( E) $30 Abstract of Judgment/Order of Utah State Tax Commission (E) $35 Judgment by Confession (E) 227 227 227 227 227 PROBATE 227 227 227 227 227 Use the Utah District Court Cover Sheet for Probate Actions for the following: Adoptions/foreign a doption s; conservatorships; estate personal rep; foreign probate; gestational agreements; guardianships; minor222s settlements; name changes; supervised administration cases; trusts; other probate actions 227 227 227 227 SPECIAL MATTERS 227 227 227 227 $35 Arbitration Award (E) $0 Determination Competency - Criminal (E) $135 Expungement Petition (E) $0 Hospital Lien (E) $35 Judicial Approval of Document: Not Part of Pending Case ( E) $35 Notice of Deposition in Out - of - State Case/Foreign Subpoena ( E) $35 Open Sealed Record (E) $50 Petition for Adjudication of Priority to Funds on Trustee's Sale American LegalNet, Inc. www.FormsWorkFlow.com