Name
Address
City, State, Zip
Phone
Email
I am the[ ] Defendant
[ ] Parent or Guardian of theDefendant
In the [ ] District [ ] Juvenile [ ] Justice Court of Utah
______Judicial District______County
Court Address ______
______
Plaintiff
v.
______
Defendant / Affidavit of No Unlawful Alcohol Consumption
______
Case Number
______
Judge

Being first sworn and under oath or affirmation, I say as follows:(Choose one)

[ ]I am the defendant in this case, and I am 18 years of age or older. I have not unlawfully consumed alcohol during the period of license suspension or denial.

[ ]I am the parent or legal guardian of the defendant, who is under 18 years of age. To the best of my knowledge the defendant has not unlawfully consumed alcohol during the period of license suspension or denial.

I have not included any non-public information in this document.
Sign here ►
Date / Typed or Printed Name
On this date, I certify that ______(name)who is known to me or who presented satisfactory identification, in the form of ______(form of identification), has, while in my presence and while under oath or affirmation, voluntarily signed this document and declared that it is true.
Sign here ►
Date / Typed or printed name (Court Clerk or Notary Public)
Notary Seal
Certificate of Service
I certify that I served a copy of this Affidavit of No Unlawful Alcohol Consumptionon the following people.
Person’s Name / Method of Service / Served at this Address / Served on this Date
(Prosecuting Attorney) / [ ] Mail
[ ] Hand Delivery
[ ] E-filed
[ ] Email (Person agreed to service by email.)
[ ] Left at business (With person in charge or in receptacle for deliveries.)
[ ] Left at home (With person of suitable age and discretion residing there.)
(Clerk of Court) / [ ] Mail
[ ] Hand Delivery
[ ] E-filed
Sign here ►
Date / Typed or Printed Name
Affidavit of No Unlawful Alcohol Consumption / Approved Boards of JudgesMay 4, 13, 20, 2011
Revised May 9, 2017 / Page 1 of 3