Small Claims Request For Verification Of Employment - Salt Lake City Justice Court Page 3
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4SALT LAKE CITY JUSTICE COURT
333 SOUTH 200 EAST, PO BOX 145499, SALT LAKE CITY, UT 84111-5499
Phone: 801-535-6301 / Fax: 801-535-6302 /
Name__________________________________________Plaintiff
)
JUDGMENT
vs.
)
INFORMATION SHEET
Name________________________________________Defendant
)
AND
)
Name________________________________________Defendant
)
Case No.____________________
1. The
Plaintiff
Defendant in this action, as judgment creditor, provides the following information in compliance with
Section 78A-2-216.
2. The correct name of the judgment debtor is ____________________________________________.
3. The correct last known address of the judgment debtor is _______________________________________________.
4. The address at which the judgment debtor received service of process is ___________________________________
_________________________________________________________________________________________________.
5. The judgment debtor is
not a natural person,
a natural person and
a. the social security number of the judgment debtor is __________________(last 4 digits only),
b. the date of birth of the judgment debtor is __________________________(year and month of birth), and
c. the driver’s license number of the judgment debtor is _________________(last 4 digits only),
6. The name of the judgment creditor is _______________________________________________________.
7. The amount of the judgment is $_____________________.
8. The judgment was entered on_______________________________________.
9. The
judgment has not been stayed.
The judgment has been stayed, and the stay expires on
_______________________________.
11. The judgment creditor has reviewed its own records, the records of its attorney and the records of the court in which the
judgment was entered. Any information required by Section 78B-5-201 but not provided in this statement is unknown and
unavailable.
___________________________________
Attorney
Judgment Creditor
Party Name: _____________________
Party Address: ___________________
________________________________
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