Name Address City, State, Zip Phone Email I am the [ ] Plaintiff [ ] Attorney for the Plaintiff and my Utah Bar number is _______ In the Justice Court of Utah __________ Judicial District ________________ County Court Address ______________________________________________________ _____________________________________ Affidavit and Summons (Small Claims) Plaintiff v. _______________________________ _____________________________________ Case Number Defendant And _____________________________________ Defendant _______________________________ Judge I swear that the following is true. (1) Defendant owes me $ for the claim described in paragraph (2). plus the filing fee of $ plus an estimated service fee of $ plus estimated attorney fees of $ for a total of: $ plus prejudgment interest, if qualified for prejudgment interest. (Attach statute or contract showing you are authorized to claim attorney fees.) Affidavit and Summons (Small Claims) Approved Board of Justice Court Judges September 22, 2010 Revisions Approved by Supreme Court July 18, 2016 Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com (2) The events happened on _________________________ (date). My claim is based on the following facts. (3) (4) (5) (6) [] [] [] [] [] Defendant resides within the jurisdiction of the court. The events happened within the jurisdiction of the court. I am not suing a government entity. I am not suing a government employee for the employee's on-the-job conduct. I am not suing on a claim that has been assigned to me. I am filing this affidavit in the First District Court for Cache County because the defendant resides in unincorporated Cache County or in a municipality within Cache County that does not have a justice court and the cause of action arose in unincorporated Cache County or in a municipality within Cache County that does not have a justice court. I have not included any non-public information in this document. Sign here Date Typed or Printed Name I certify that __________________________, who is known to me or who presented satisfactory identification, has, while in my presence and while under oath or affirmation, voluntarily signed this document and declared that it is true. Sign here Date Typed or printed name (Court Clerk or Notary Public) Notary Seal Affidavit and Summons (Small Claims) Approved Board of Justice Court Judges September 22, 2010 Revisions Approved by Supreme Court July 18, 2016 Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Summons To: Defendant Name and Address Para: Nombre y dirección del Demandado Defendant Name and Address Nombre y dirección del Demandado You are summoned to appear at trial to answer the above claim. The trial will be held at the court address shown above. If you fail to appear, judgment may be entered against you for the total amount claimed. Se le cita a comparecer a juicio para responder al reclamo arriba descrito. El juicio tendrá lugar en la dirección del tribunal que se muestra arriba. Si usted no comparece, se podría dictar un fallo contra usted por el total de la cantidad reclamada. Date (Fecha) Room (Sala) Time (Hora) Judge (Juez) Notice to the Defendant : [ ] a.m. [ ] p.m. A small claims case has been filed against you. This imposes upon you certain rights and responsibilities. You can find small claims information and instructions at https://www.utcourts.gov/howto/smallclaims/. The court's Finding Legal Help web page (www.utcourts.gov/howto/legalassist/) provides information about the ways you can get legal help, including the Self-Help Center, reduced-fee attorneys, limited legal help and free legal clinics. Un caso de reclamos menores ha sido presentado contra usted. Esto le impone a usted ciertos derechos y obligaciones. Usted puede encontrar información e instrucciones sobre reclamos menores en https://www.utcourts.gov/howto/smallclaims/. La página del tribunal sobre Como Encontrar Ayuda Legal (www.utcourts.gov/howto/legalassist/) proporciona información acerca de las maneras en que usted puede obtener ayuda legal, incluyendo el Centro de Ayuda del tribunal, abogados a precio reducido, ayuda legal limitada y talleres jurídicos gratuitos. Affidavit and Summons (Small Claims) Approved Board of Justice Court Judges September 22, 2010 Revisions Approved by Supreme Court July 18, 2016 Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Attendance. You must attend. If you do not attend, the relief requested might be granted. You have the right to be represented by a lawyer. Asistencia. Presentarse es obligatorio. Si usted no llegara a presentarse, el remedio solicitado podría ser otorgado. Usted tiene el derecho de que lo represente un abogado. Evidence. Bring with you any evidence that you want the court to consider. Pruebas. Traiga con usted cualquier prueba que quiera que el tribunal tome en cuenta. Interpretation. If you do not speak or understand English, contact court staff at least 3 days before the hearing, and an interpreter will be provided. Interpretación. Si usted no habla ni entiende el Inglés contacte al personal del tribunal por lo menos 3 días antes de la audiencia y le proveerán un intérprete. Disability Accommodation. If you have a disability requiring accommodation, including an ASL interpreter, contact court staff at least 3 days before the hearing. Atención en caso de incapacidades. Si usted tiene una incapacidad por la cual requiere atención especial, favor de contactar al personal del tribunal por lo menos 3 días antes de la audiencia. Right to Jury Trial. If you want to have a jury trial in this case, you must file documents to remove the case to district court. See the Small Claims web page for information about that process, and forms: https://www.utcourts.gov/howto/smallclaims/. El derecho a juicio por jurado. Si usted quiere tener un juicio con jurado, usted deberá presentar documentos pidiendo que el caso sea transferido al tribunal de distrito. Vea la página de internet de Reclamos Menores para más información sobre el proceso y formularios: https://www.utcourts.gov/howto/smallclaims/. Date: Sign here Court Clerk Affidavit and Summons (Small Claims) Approved Board of Justice Court Judges September 22, 2010 Revisions Approved by Supreme Court July 18, 2016 Page 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com