Cover Sheet for Civil Filing Actions - 5/9/2017



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.

Interpretación. Si usted no habla o entiende el Inglés contacte al tribunal por lo menos 3 días antes de la audiencia o mediación y le proveerán un intérprete.

Plaintiff/Petitioner (First)

| |

|Name |

| |

|Address |

| |

|City, State, Zip |

| | | |

|Phone | |Email |

First Plaintiff/Petitioner’s Attorney*

| |

|Name |

| |

|Bar Number |

----------------------------------------------------------------------------------

Plaintiff/Petitioner (Second)

| |

|Name |

| |

|Address |

| |

|City, State, Zip |

| | | |

|Phone | |Email |

Second Plaintiff/Petitioner’s Attorney*

| |

|Name |

| |

|Bar Number |

| |

Defendant/Respondent (First)

| |

|Name |

| |

|Address |

| |

|City, State, Zip |

| | | |

|Phone | |Email |

First Defendant/Respondent’s Attorney*

| |

|Name |

| |

|Bar Number |

----------------------------------------------------------------------------

Defendant/Respondent (Second)

| |

|Name |

| |

|Address |

| |

|City, State, Zip |

| | | |

|Phone | |Email |

Second Defendant/Respondent’s 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: §78a-2-301 (Choose ( all that apply. See Page 2 for fees for claims other than claims for damages.)

|PLEASE CHOOSE ONE: |

| |No monetary damages are requested |

| |(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) |

| |Damages are unspecified. |

| |Circle one: Tier 1 Tier 2 Tier 3 |

| |This case is exempt from URCP 26. (E) |

| |

|— — MOTION TO RENEW JUDGMENT — — |

|$37.50 |Damages $2000 or less |

|$92.50 |Damages $2001 - $9,999 |

|$180 |Damages $10,000 & over |

|— — COMPLAINT OR INTERPLEADER — — |

|$75 |Damages $2000 or less |

|$185 |Damages $2001 - $9999 |

|$360 |Damages $10,000 & over |

|$360 |Damages Unspecified |

|— — COUNTERCLAIM, CROSS CLAIM, THIRD PARTY CLAIM, OR INTERVENTION — —|

|$55 |Damages $2000 or less |

|$150 |Damages $2001 - $9999 |

|$155 |Damages $10,000 & over |

Choose ( One

|Fee |Case Type |

|— — — — — APPEALS — — — — — |

|$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 Novo (E) |

|— — — — GENERAL CIVIL — — — — |

|Sch |Civil Rights |

|$0 |Civil Stalking (E) |

|$360 |Condemnation/Eminent Domain |

|Sch |Contracts |

|Sch |Contract: Employment Discrimination |

|Sch |Contract: Fraud |

|Sch |Debt Collection |

|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 |

|— — — — — — — TORTS — — — —— — — |

|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 |

|— — — — DOMESTIC RELATIONS — — — — |

|$0 |Protective Orders (E) |

|$310 |Marriage Adjudication (T2) |

|$310 |Custody/Visitation/Support (T2) |

|$310 |Divorce/Annulment (T2) |

| |Check if child support, custody or parent-time will be |

| |part of decree |

| |Check if Temporary Separation filed |

|$8 |Vital Statistics §26-2-25 per form |

|$115 |Counterclaim: Divorce/Sep Maint. |

|$115 |Counterclaim: Custody/Visit/Support |

|$155 |Counterclaim: Paternity/Grandparent |

| |Visitation |

|$100 |Domestic Modification (T2) |

|$100 |Counter-petition: Domestic Mod. |

|$360 |Grandparent Visitation (T2) |

|$360 |Paternity/Parentage (T2) |

|$310 |Separate Maintenance (T2) |

|$35 |Temporary Separation (E) |

|$35 |Uniform Child Custody Jurisdiction & Enforcement Act |

| |(UCCJEA) (E) |

|$35 |Uniform Interstate Family Support Act (UIFSA) (E) |

|— — — — — JUDGMENTS — — — — — |

|$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) |

|— — — — — PROBATE — — — — — |

|$360 |Adoption/Foreign Adoption (T2) |

|$8 |Vital Statistics §26-2-25 per form |

|$360 |Conservatorship (T2) |

|$360 |Estate Personal Rep (T2) |

|$35 |Foreign Probate/Child Custody Doc. (E) |

|$360 |Gestational Agreement (T2) |

|$360 |Guardianship-Adult (T2) |

|$360 |Guardianship-Minor (T2) |

|$35 |Guardianship-Disabled Adult Child (T2) |

|$0 |Involuntary Commitment (T2) |

|$360 |Minor’s Settlement (T2) |

|$360 |Name Change (T2) |

|$360 |Supervised Administration (T2) |

|$360 |Trusts (T2) |

|$360 |Unspecified (Other) Probate (T2) |

|— — — — SPECIAL MATTERS — — — — |

|$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 |

| | |

|Name | |

| | |

|Address | |

| | |

|City, State, Zip | |

| | |

|Phone | |

| | |

|Email | |

|I am [ ] Petitioner |

|[ ] Petitioner’s Attorney (Utah Bar #:__________) |

|In the District Court of Utah |

|__________ Judicial District ________________ County |

|Court Address ______________________________________________________ |

|In the Matter of the Name Change of: |Petition for Name Change & Gender Marker Change |

|_____________________________________ |_______________________________ |

|Petitioner |Case Number |

| |_______________________________ |

| |Judge |

Petitioner states as follows:

(1) I live in ____________________________ County, Utah and have lived here for more than one year.

(2) The name on my birth certificate is:

|First name | |

|Middle name (if any) | |

|Surname | |

(3) I ask the court to order that my legal name be (proposed new name):

|First name | |

|Middle name (if any) | |

|Surname on birth certificate | |

|Married surname (if any) | |

(4) I want to change my name because:

| |

| |

(5) I do not know any reason why I should not be allowed to change my name.

(6) Except for this petition, I am not involved in any court actions or proceedings.

(7) I am not on probation or parole.

(8) I am not barred as a sex offender under Utah Code 77-41-105(9), or as a child abuse offender under Utah Code 77-43-105(7) from changing my name. I am filing a Certification Regarding Offender Registry completed by the Utah Department of Corrections showing that there were no search results for my name.

(9) I am not changing my name to avoid creditors or anyone else with a claim against me.

(10) My name change will not affect any right, title, or interest of anyone else, and I do not know of anyone else who should be notified of this petition.

| |Signature ► | |

|Date |Printed Name | |

|On this date, I certify that _________________________________________________________ (name) who is known to me or who presented satisfactory|

|identification, in the form of ______________________________________________________ (form of identification), has, while in my presence and |

|while under oath or affirmation, voluntarily signed this document and declared that it is true. |

| |Signature ► | |

|Date |Printed name (Court Clerk or Notary Public) | |

|Notary Seal | |

| | |

|Name |

| |

|Address |

| |

|City, State, Zip |

| |

|Phone |

| |

|Email |

|I am the [ ] Petitioner |

|[ ] Attorney for the Petitioner and my Utah Bar number is _________ |

|In the District Court of Utah |

|__________ Judicial District ________________ County |

|Court Address ______________________________________________________ |

|In the Matter of the Name Change of: |Request for Hearing on Petition for Name Change & Gender Marker |

|_____________________________________ |Change |

|Petitioner |_______________________________ |

| |Case Number |

| |_______________________________ |

| |Judge |

(1) I request a hearing on my Petition for Name Change.

| |Sign here ► | |

|Date |Typed or Printed Name | |

| | |

|Name |

| |

|Address |

| |

|City, State, Zip |

| |

|Phone |

| |

|Email |

|In the District Court of Utah |

|__________ Judicial District ________________ County |

|Court Address ______________________________________________________ |

|In the Matter of the Name Change of: |Order on Petition for Name Change & Gender Marker Change |

|_____________________________________ |_______________________________ |

|Petitioner |Case Number |

| |_______________________________ |

| |Judge |

(1) Petitioner appeared in court on _______________________ (date).

(2) Petitioner was born on: _______________________ (date).

(3) The name on petitioner’s birth certificate is:

|First name | |

|Middle name (if any) | |

|Surname | |

THE COURT FINDS:

(4) (a) All the notices required by law have been given.

(b) [ ] No objections to the proposed name change were made

(c) [ ] Objections to the proposed name change were made by:

________________________________________________________________

(d) [ ] Other findings (if any):

| |

THE COURT CONCLUDES:

(5) (a) The requirements of Utah Code Section 42-1-1 through 42-1-3 have been met and Utah Code Section 77-41-105(9) does not prohibit this order.

(b) It appears to the satisfaction of the court that the allegations in the petition are true and sufficient and that the petition should be granted.

Having considered the documents filed with the court, the evidence and the arguments, and now being fully informed,

THE COURT ORDERS:

(1) The Petition is

[ ] granted

[ ] denied

(2) [ ] Petitioner’s legal name is changed to:

|First name | |

|Middle name (if any) | |

|Surname on birth certificate | |

|Married surname (if any) | |

The Petitioner may use this new legal name from this date forward.

| |Sign here ► | |

|Date |Judge | |

|Certificate of Service |

|I certify that I served a copy of this Order on Petition for Name Change on the following people (only if there were other interested parties|

|in this case). |

|Person’s Name |Method of Service |Served at this Address |Served on this |

| | | |Date |

|(Interested Party or Attorney) |[ ] Mail | | |

| |[ ] Hand Delivery | | |

| |[ ] E-filed | | |

| |[ ] Fax (Person agreed to service by fax.) | | |

| |[ ] Email (Person agreed to service by 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.) | | |

|(Interested Party or Attorney) |[ ] Mail | | |

| |[ ] Hand Delivery | | |

| |[ ] E-filed | | |

| |[ ] Fax (Person agreed to service by fax.) | | |

| |[ ] Email (Person agreed to service by 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 here ► | |

|Date |Typed or Printed Name | |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download