County Justice Court Form

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DAVIS COUNTY JUSTICE COURT
800 W STATE ST, FARMINGTON UT 84025
Courtroom #2
Plaintiff,
____________________________________
Name
_________________________________________________
Agent & Title
_________________________________________________
Address
SMALL CLAIMS AFFIDAVIT
_________________________________________________
AND ORDER
City, State, Zip
Phone
VS.
Defendant,
____________________________________
Name
_________________________________________________
DOCKET #______________________________
Agent & Title
_________________________________________________
Address
_________________________________________________
City, State, Zip
Phone
Defendant,
____________________________________
Name
_________________________________________________
Agent & Title
_________________________________________________
Address
_________________________________________________
City, State, Zip
Phone
AFFIDAVIT
I swear the following is true:
Defendant owes me
$_______________
(1)
for the claim described in paragraph (2).
Plus the court filing fee
$_______________
Plus an estimated service fee of
$_______________
For a total of
$_______________
(2) This claim arose on _______________ for: __________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
(3) Defendant resides or the claim arose within the jurisdiction of this court.
Plaintiff:_____________________________________
By:__________________________________________
(Agent’s name and title, if appropriate)
SUBSCRIBED and SWORN to before me on ___________________________,20__________
_____________________________________________________
Clerk, Deputy or Notary
SUMMONS
THE STATE OF UTAH TO THE DEFENDANT: You are directed to appear at a trial and answer
the above claim:
Date_____________________________________ at (time)_____________________
Courtroom #2, 800 W. State St. Farmington, UT
If you fail to appear at the trial, judgment may be entered against you for the amount listed
above.
_________________________________
___________________________________________________
Date
Clerk or Deputy
NOTICE TO 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 free at:
ADA NOTICE: If you need special accommodations (including communication aids and services) during this
proceeding contact the clerks’ office at (801)451-4488 at least three days before the proceeding.
sc1/Sept, 2010

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