______

(Name)

______

(Address)

______

(City)

______

(Telephone)

______DISTRICT COURT, ______COUNTY, UTAH
COURT’S ADDRESS: ______
IN THE MATTER OF THE
NAME CHANGE OF:
______,.
(minor’s name) / RETURN OF SERVICE
A minor. / Case No. ______
Judge ______

______, Affiant, being first sworn and under oath,

(Name of person who served Summons and Petition)

deposes and says:

1.Affiant resides in ______County, State of ______.

(name of county) (name of state)

Affiant is more than 18 years old and does not have an interest in this action.

2.  Affiant received the Summons and Petition for this action on ______.

(date)

3.Affiant personally served Respondent with the Summons and Petition in

______County, on ______, at

(name of county) (date)

______. At the time of service,

(address where served)

Affiant knew that the person served was the Respondent in this action.

4. At the time of service of the Summons and Petition, Affiant also served Respondent personally with the following additional documents: ______

______

______

5.At the time of service, Affiant wrote the date and place of service on the copy of the

Summons left for the person being served. Affiant also signed Affiant’s name and added Affiant’s official title, if an officer, to the Summons.

DATED: ______

Affiant (Person serving the Summons)

NOTARY CLAUSE

______, Affiant, is personally known to me or presented satisfactory proof of identity. After being sworn and while under oath, Affiant stated that he or she was acting voluntarily, had read and understood the preceding document, and that the contents were true. Affiant then signed the document in my presence.

Signed on ______, 20____. X______

Notary Public/Court clerk

(Notary Seal)

Minor’s Name Change: Return of Service, p. 1 Approved: November 19, 2004