County Justice Court Form (Page 2 of 3) in pdf

DAVIS COUNTY JUSTICE COURT

800 W STATE ST, FARMINGTON UT 84025

Courtroom #2

Plaintiff,

____________________________________

Name

_________________________________________________

Agent & Title

_________________________________________________

Address

MILITARY SERVICE 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

I am the plaintiff in this case. To support my application for a default judgment and to comply with the

Servicemembers Civil Relief Act, I swear of affirm that:

[ ] the Defendant is in the military service.

[ ] the Defendant is not in the military service.

[ ] I am unable to determine Defendant’s military service status.

I have done the following research to support the above conclusion:

________________________________________________________________________________________________________

[ ] (A certificate from the Department of Defense Manpower Data Center is the preferred evidence of

military service status. Check this box only if you have attached that certificate.) I visited the

Department of Defense Manpower Data Center website

(https://

) to inquire about military service, and I entered the

following indentifying information for the Defendant, which I know to be correct:

Name:___________________________________________________ Date of Birth____________________________

Last 4 digits of social security number______________________

[ ] I know the identifying information to be correct because:_____________________________________________

_______________________________________________________________________________________________________

[ ] I do not know and am unable to discover the Defendant’s date of birth or social security number.

I have mailed a copy of this affidavit to the defendant at the following address:

____________________________________________________

Date_______________________________

Plaintiff______________________________________________________

_______________________________,plaintiff, is personally known to me or presented satisfactory proof of

identity to me. After being sworn and while under oath, plaintiff stated that he/she was acting

voluntarily, had read and understood the preceding document, and the at the contents were true.

Plaintiff then signed the document in my presence.

Date_______________________________

Clerk/Notary_________________________________________________

Seal

ORDER

Pursuant to the above affidavit and the Servicemembers Civil Relief Act, the Court ORDERS that:

[ ] The plaintiff does not need to file a bond.

[ ] The plaintiff must file a bond in the amount of $______________________

[ ] The court appoints ___________________________________as attorney to represent the Defendant.

Date_______________________________

Judge_________________________________________________________

sc2/Sept, 2010

County Justice Court Form Page 2

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