JUSTICE/DISTRICT COURT OF ____________________ COUNTY/CITY _____________ JUDICIAL DISTRICT ADDRESS: _______________________________________________ ______________________________________________, Plaintiff Name ______________________________________________________ Street Address ______________________________________________________ City, State, Zip SMALL CLAIMS AFFIDAVIT AND SUMMONS (FORM B) VS. ____________________________________________, Defendant Name ______________________________________________________ Street Address ______________________________________________________ City, State, Zip Case No. _____________________ AND ____________________________________________, Defendant Name ______________________________________________________ Street Address ______________________________________________________ City, State, Zip AFFIDAVIT I swear that the following is true: (1) Defendant owes me $ plus the court filing fee of plus an estimated service fee of for a total of: for the claim described in paragraph (2). $ $ $ plus prejudgment interest to the date of judgment, if qualified for prejudgment interest. (2) This claim arose on _____________________ for: American LegalNet, Inc. www.FormsWorkflow.com (3) Defendant resides or the claim arose within the jurisdiction of this court. Plaintiff’s or Agent’s Signature Subscribed and sworn to before me on ________________________. Clerk’s or Notary’s Signature SUMMONS THE STATE OF UTAH TO THE DEFENDANT: You are summoned to appear at trial to answer the above claim. The trial will be held at the court address shown above. Date of trial Time of trial If you fail to appear, judgment may be entered against you for the amount listed above. Date Clerk’s Signature NOTICE TO THE DEFENDANT: A small claims case has been filed against you. This imposes upon you certain rights and responsibilities. If you need information, you may obtain a small claims information and instruction manual from the clerk of the court for a fee or you may obtain it for free at: www.utcourts.gov. ADA NOTICE: If you need special accommodations (including communication aids and services) during this proceeding should call (name)__________________ at (phone)_________, at least three days before the proceeding. American LegalNet, Inc. www.FormsWorkflow.com