1 107GEJ Approved April 1 6 , 2018 / Revised May 1, 2019 Statement Supporting Motion Page 1 of 3 [ ] This is a private record Name Address City, State, Zip Phone Email In the [ ] District [ ] Justice Court of Utah Judicial District County Court Address Plaintiff/Petitioner v. Defendant/Respondent Statement Supporting Motion to (name of motion) Case Number Judge Commissioner (domestic cases) I am the (describe connection to the moving party) of the [ ] plaintiff/petitioner [ ] defendant/respondent. 1. I say the following: (Write in clear, simple sentences. You must have personal knowledge of the facts stated.) American LegalNet, Inc. www.FormsWorkFlow.com 1 107GEJ Approved April 1 6 , 2018 / Revised May 1, 2019 Statement Supporting Motion Page 2 of 3 2. List any documents you have attached that support your statements. I declare under criminal penalty under the law of Utah that everything stated in this document is true . Signed at (city, and state or country). Sign atu Date Printed Name American LegalNet, Inc. www.FormsWorkFlow.com 1 107GEJ Approved April 1 6 , 2018 / Revised May 1, 2019 Statement Supporting Motion Page 3 of 3 Certificate of Service I certify that I filed with the court and am serving a copy of this S tatement Supporting Motion on the following people. Ser vice Method Service Address Service Date [ ] Mail [ ] Hand Delivery [ ] E - filed [ ] Email [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing ther e.) [ ] Mail [ ] Hand Delivery [ ] E - filed [ ] Email [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing there.) [ ] Mail [ ] Hand Delivery [ ] E - filed [ ] Email [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing there.) Sign atu Date Printed Name American LegalNet, Inc. www.FormsWorkFlow.com