Affidavit And Summons (Small Claims) Form printable pdf download

Affidavit And Summons (Small Claims) Form

Name

Address

City, State, Zip

Phone

I am the [ ] Plaintiff

[ ] Attorney for the Plaintiff and my Utah Bar number is _______

In the Justice Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

Affidavit and Summons

_____________________________________

(Small Claims)

Plaintiff

_______________________________

_____________________________________

Case Number

Defendant

_______________________________

And

Judge

_____________________________________

Defendant

I swear that the following is true.

(1) Defendant owes me

for the claim described in paragraph (2).

plus the filing fee of $

plus an estimated service fee of $

(Attach statute or contract showing you are

plus estimated attorney fees of $

authorized to claim attorney fees.)

for a total of: $

plus prejudgment interest, if qualified for prejudgment interest.

Affidavit and Summons (Small Claims)

Approved Board of Justice Court Judges September 22, 2010

Page 1 of 4

Revisions Approved by Supreme Court July 18, 2016

Affidavit And Summons (Small Claims) Form