Name Address City, State, Zip Phone Email I am the [ ] Defendant [ ] Attorney for the Defendant and my Utah Bar number is _______ In the Justice Court of Utah __________ Judicial District ________________ County Court Address ______________________________________________________ _____________________________________ Counter Affidavit and Summons (Small Claims) Plaintiff v. _____________________________________ Defendant _______________________________ Case Number _______________________________ Judge And _____________________________________ Defendant I swear that the following is true. (1) Plaintiff owes me plus the filing fee of plus estimated attorney fees of for a total of: $ $ (Attach statute or contract showing you are authorized to claim attorney fees.) $ for the claim described in paragraph (2). plus prejudgment, if qualified for prejudgment interest. Counter 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) [] [] [] 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 understand that I may be barred from later bringing any claims arising out of the event or transaction if the claims are not described in this affidavit. I understand that I have the right to move this case to the district court where I could ask for a jury trial. By deciding to keep this case in the justice court, I waive my right to a jury trial. I have not included any non-public information in this document. Date: Sign here Printed Name. Defendant or Defendant's Agent 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. Date: Sign here Notary or Court Clerk Notary Seal Counter 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: Plaintiff Name and Address Nombre y direcci�n del Demandante Para: 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 tendr� lugar en la direcci�n del tribunal que se muestra arriba. Si usted no comparece, se podr�a dictar un fallo contra usted por el total de la cantidad reclamada. The original trial date (La fecha original para juicio) [ ] has not changed no ha sido cambiada [ ] has been changed to: ha sido cambiada para: Date (Fecha) Room (Sala) Time (Hora) Judge (Juez) Notice to the Plaintiff : [ ] a.m. [ ] p.m. A counterclaim 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 contrademanda ha sido presentado contra usted. Esto le impone a usted ciertos derechos y obligaciones. Usted puede encontrar informaci�n e instrucciones sobre reclamos menores en https://www.utcourts.gov/howto/smallclaims/. La p�gina del tribunal sobre Como Encontrar Ayuda Legal (www.utcourts.gov/howto/legalassist/) proporciona informaci�n 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 jur�dicos gratuitos. Counter 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 podr�a 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. Interpretaci�n. Si usted no habla ni entiende el Ingl�s contacte al personal del tribunal por lo menos 3 d�as antes de la audiencia y le proveer�n un int�rprete. Disability Accommodation. If you have a disability requiring accommodation, including an ASL interpreter, contact court staff at least 3 days before the hearing. Atenci�n en caso de incapacidades. Si usted tiene una incapacidad por la cual requiere atenci�n especial, favor de contactar al personal del tribunal por lo menos 3 d�as antes de la audiencia. Date Sign here Court Clerk Certificate of Service I certify that I mailed a copy of this document to the following people. Person's Name Address Date Sent Date Sign here Court Clerk Counter 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