Small Claims Affidavit & Summons/small Claims Military Service Declaration - Salt Lake City Justice Court
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3SALT 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 )
SMALL CLAIMS
Street Address___________________________________________________________ )
AFFIDAVIT & SUMMONS
City, State, Zip__________________________________________________________ )
Telephone No.___________________________________________________________ )
Email Address___________________________________________________________ )
vs.
)
Name_________________________________________________________ Defendant )
Case No._________________________
Street Address___________________________________________________________ )
City, State, Zip___________________________________________________________ )
Telephone No.___________________________________________________________ )
Email Address___________________________________________________________ )
And
(Please check what applies.)
Defendant or
)
Name________________________________________________
Registered Agent )
Street Address___________________________________________________________ )
City, State, Zip___________________________________________________________ )
Telephone No.___________________________________________________________ )
Email Address___________________________________________________________ )
AFFIDAVIT
I swear that the following is true:
(1) Defendant Owes me
$______________ for the claim described in paragraph (2)
plus the court filing fee of
$______________
plus an estimated service fee of
$______________
plus estimated attorney fees of
$______________
(attach statute or contract showing you are authorized to claim attorney fees.)
for a total of
$______________ plus prejudgment interest, if qualified.
(2) The events happened on (date)___________________. My claim is based on the following facts. ________________________________
_________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
(3)
Defendant resides within the jurisdiction of this court.
The events happened within the jurisdiction of this court.
(4)
I am not suing a government entity.
I am not suing a government employee for the employee’s on-the-job conduct
(5)
I am not suing on a claim that has been assigned to me. (6)
I agree to receive all future court filings or court correspondence by
email transmitted by the court. (optional) (7)
I understand, if my affidavit and summons are not served within 120 days, my case will be
dismissed pursuant to Rule 3(b) of the Utah Rules of Small Claims Procedure and Rule 4(b)(i)of the Utah Rules of Civil Procedure.
I have not included any non-public information on this document.
Sign here ►
Date
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.
Court Clerk or Notary Sign here ►
Date
Notary Seal►
SUMMONS
THE STATE OF UTAH TO THE ABOVE NAMED DEFENDANT(S): You are summoned to appear at trial, at: 333 South 200 East, Salt
Lake City, UT 84111 to answer the above claim. If you fail to appear at the trial, judgment may be entered against you for the total
amount claimed.
Date of trial: _________________________________________
Time: 5:30 pm
Court Clerk Sign here ►
Date
Disability Accommodations: If you need accommodation of a disability, contact a judicial service assistant at least 3 days before the hearing.
FOR MORE INSTRUCTIONS, PLEASE REFER TO OUR WEBSITE AT:
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