Cover Sheet for Civil Actions

Interpretation. If you do not speak or understand English, contact the court at least 3 days before the hearing or mediation, and an interpreter will be provided.

Interpretación.Si usted no habla o entiende el Inglés contacte al tribunal por lo menos 3 días antes de la audiencia o mediación y le proveerán un intérprete.

Civil Cover Sheet / Revised May 9, 2017 / Page 1

Cover Sheet for Civil Actions

Plaintiff/Petitioner(First)

Name
Address
City, State, Zip
Phone / Email

First Plaintiff/Petitioner’s Attorney*

Name
Bar Number

------

Plaintiff/Petitioner(Second)

Name
Address
City, State, Zip
Phone / Email

Second Plaintiff/Petitioner’s Attorney*

Name
Bar Number

Defendant/Respondent(First)

Name
Address
City, State, Zip
Phone / Email

FirstDefendant/Respondent’s Attorney*

Name
Bar Number

------

Defendant/Respondent(Second)

Name
Address
City, State, Zip
Phone / Email

Second Defendant/Respondent’s Attorney*

Name
Bar Number
*Attorney mailing and email addresses provided by Utah State Bar.
Civil Cover Sheet / Revised May 9, 2017 / Page 1

Cover Sheet for Civil Actions

Total Claim for Damages$______Jury Demand Yes No $250 Jury Demand


Schedule of Fees: §78a-2-301(Choose  all that apply. See Page 2 for fees for claims other than claims for damages.)

Civil Cover Sheet / Revised May 9, 2017 / Page 1
PLEASE CHOOSE ONE:
No monetary damages are requested
(URCP 26: Tier 2)
Damages requested are $50,000 or less (URCP 26: Tier 1)
Damages requested are more than $50,000 and less than $300,000 (URCP 26: Tier 2)
Damages requested are $300,000 or more (URCP 26: Tier 3)
Damages are unspecified.
Circle one: Tier 1 Tier 2 Tier 3
This case is exempt from URCP 26.(E)
— — MOTION TO RENEW JUDGMENT — —
$37.50 / Damages $2000 or less
$92.50 / Damages $2001-$9,999
$180 / Damages $10,000 & over
— — COMPLAINT OR INTERPLEADER— —
$75 / Damages $2000 or less
$185 / Damages $2001 - $9999
$360 / Damages $10,000 & over
$360 / Damages Unspecified
— — COUNTERCLAIM, CROSS CLAIM, THIRD PARTY CLAIM, OR INTERVENTION — —
$55 / Damages $2000 or less
$150 / Damages $2001 - $9999
$155 / Damages $10,000 & over
Civil Cover Sheet / Revised May 9, 2017 / Page 1

Choose  One

Civil Cover Sheet / Revised May 9, 2017 / Page 1
Fee / Case Type
— — — — — APPEALS — — — — —
$360 / Administrative Agency Review
Sch / Tax Court (Appeal of Tax Commission Decision)
Court: Refer to Clerk of Court upon filing.
$225 / Civil (78A-2-301(1)(h))(E)
$225 / Small Claims Trial De Novo(E)
— — — — GENERAL CIVIL — — — —
Sch / Civil Rights
$0 / Civil Stalking(E)
$360 / Condemnation/Eminent Domain
Sch / Contracts
Sch / Contract: Employment Discrimination
Sch / Contract: Fraud
Sch / Debt Collection
Sch / Eviction/Forcible Entry and Detainer(E)
$360 / Extraordinary Relief/Writs
$360 / Forfeiture of Property(E)
Sch / Interpleader
Sch / Lien/Mortgage Foreclosure
Sch / Miscellaneous Civil
$360 / Post Conviction Relief: Capital(E)
$360 / Post Conviction Relief: Non-capital(E)
Sch / Property Rights
$360 / Registry Removal (Gun/White Collar)
Sch / Sexual Harassment
Sch / Water Rights
$360 / Wrongful Lien
Sch / Wrongful Termination
— — — — — — — TORTS — — — —— — —
Sch / Automobile Tort
Sch / Intentional Tort
Sch / Malpractice-Medical Tort
Sch / Malpractice-Legal Tort; Other
Sch / Premises Liability
Sch / Asbestos
Sch / Product Liability (NOT Asbestos)
Sch / Slander/Libel/Defamation
— — — — DOMESTIC RELATIONS — — — —
$0 / Protective Orders (E)
$310 / Marriage Adjudication (T2)
$310 / Custody/Visitation/Support (T2)
$310 / Divorce/Annulment(T2)
Check if child support, custody or parent-time will be part of decree
Check if Temporary Separation filed
$8 / Vital Statistics §26-2-25 per form
$115 / Counterclaim: Divorce/Sep Maint.
$115 / Counterclaim: Custody/Visit/Support
$155 / Counterclaim: Paternity/Grandparent
Visitation
$100 / Domestic Modification(T2)
$100 / Counter-petition: Domestic Mod.
$360 / Grandparent Visitation (T2)
$360 / Paternity/Parentage (T2)
$310 / Separate Maintenance(T2)
$35 / Temporary Separation(E)
$35 / Uniform Child Custody Jurisdiction & Enforcement Act (UCCJEA)(E)
$35 / Uniform Interstate Family Support Act (UIFSA)(E)
— — — — — JUDGMENTS — — — — —
$35 / Foreign Judgment (Abstract of) (E)
$50 / Abstract of Judgment/Order of Utah Court/Agency(E)
$30 / Abstract of Judgment/Order of Utah State Tax Commission (E)
$35 / Judgment by Confession(E)
— — — — — PROBATE — — — — —
$360 / Adoption/Foreign Adoption (T2)
$8 / Vital Statistics §26-2-25 per form
$360 / Conservatorship(T2)
$360 / Estate Personal Rep(T2)
$35 / Foreign Probate/Child Custody Doc.(E)
$360 / Gestational Agreement(T2)
$360 / Guardianship-Adult (T2)
$360 / Guardianship-Minor (T2)
$35 / Guardianship-Disabled Adult Child (T2)
$0 / Involuntary Commitment(T2)
$360 / Minor’s Settlement(T2)
$360 / Name Change(T2)
$360 / Supervised Administration(T2)
$360 / Trusts(T2)
$360 / Unspecified (Other) Probate (T2)
— — — — SPECIAL MATTERS — — — —
$35 / Arbitration Award(E)
$0 / Determination Competency-Criminal(E)
$135 / Expungement Petition(E)
$0 / Hospital Lien(E)
$35 / Judicial Approval of Document: Not Part of Pending Case(E)
$35 / Notice of Deposition in Out-of-State Case/Foreign Subpoena(E)
$35 / Open Sealed Record(E)
$50 / Petition for Adjudication of Priority to Funds on Trustee's Sale
Petition for Name Change / Approved November 19, 2004
Revised July 26, 2017 / Page 1 of 2
Name
Address
City, State, Zip
Phone
Email
I am [ ] Petitioner
[ ] Petitioner’s Attorney (Utah Bar #:______)
In the District Court of Utah
______Judicial District______County
Court Address ______
In the Matter of the Name Change of:
______
Petitioner / Petition for Name Change & Gender Marker Change
______
Case Number
______
Judge

Petitioner states as follows:

(1)I live in ______County, Utah and have lived here for more than one year.

(2)The name on my birth certificate is:

First name
Middle name (if any)
Surname

(3)I ask the court to order that my legal name be (proposed new name):

First name
Middle name (if any)
Surname on birth certificate
Married surname (if any)

(4)I want to change my name because:

(5)I do not know any reason why I should not be allowed to change my name.

(6)Except for this petition, I am not involved in any court actions or proceedings.

(7)I am not on probation or parole.

(8)I am not barred as a sex offender under Utah Code 77-41-105(9), or as a child abuse offender under Utah Code 77-43-105(7) from changing my name. I am filing a Certification Regarding Offender Registry completed by the Utah Department of Corrections showing that there were no search results for my name.

(9)I am not changing my name to avoid creditors or anyone else with a claim against me.

(10)My name change will not affect any right, title, or interest of anyone else, and I do not know of anyone else who should be notified of this petition.

Signature ►
Date / 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.
Signature ►
Date / Printed name (Court Clerk or Notary Public)
Notary Seal
Petition for Name Change / Page 2 of 2
Petition for Name Change / Page 2 of 2
Name
Address
City, State, Zip
Phone
Email
I am the[ ] Petitioner
[ ] Attorney for the Petitioner and my Utah Bar number is ______
In the District Court of Utah
______Judicial District ______County
Court Address ______
In the Matter of the Name Change of:
______
Petitioner / Request for Hearing on Petition for Name Change & Gender Marker Change
______
Case Number
______
Judge

(1)I request a hearing on my Petition for Name Change.

Sign here ►
Date / Typed or Printed Name
Request for Hearing on Petition for Name and Gender Change / Page 1 of 1
Name
Address
City, State, Zip
Phone
Email
In the District Court of Utah
______Judicial District ______County
Court Address ______
In the Matter of the Name Change of:
______
Petitioner / Order on Petition for Name Change & Gender Marker Change
______
Case Number
______
Judge

(1)Petitioner appeared in court on ______(date).

(2)Petitioner was born on: ______(date).

(3)The name on petitioner’s birth certificate is:

First name
Middle name (if any)
Surname

THE COURT FINDS:

(4)(a) All the notices required by law have been given.

(b) [ ] No objections to the proposed name change were made

(c) [ ] Objections to the proposed name change were made by:

______

(d) [ ] Other findings (if any):

THE COURT CONCLUDES:

(5)(a)The requirements of Utah Code Section 42-1-1 through 42-1-3 have been met and Utah Code Section 77-41-105(9) does not prohibit this order.

(b) It appears to the satisfaction of the court that the allegations in the petition are true and sufficient and that the petition should be granted.

Having considered the documents filed with the court, the evidence and the arguments, and now being fully informed,

THE COURT ORDERS:

(1)The Petition is

[ ] granted

[ ] denied

(2)[ ] Petitioner’s legal name is changed to:

First name
Middle name (if any)
Surname on birth certificate
Married surname (if any)

The Petitioner may use this new legal name from this date forward.

Sign here ►
Date / Judge
Certificate of Service
I certify that I served a copy of this Order on Petition for Name Change on the following people (only if there were other interested parties in this case).
Person’s Name / Method of Service / Served at this Address / Served on this Date
(Interested Party or Attorney) / [ ] Mail
[ ] Hand Delivery
[ ] E-filed
[ ] Fax (Person agreed to service by fax.)
[ ] 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.)
(Interested Party or Attorney) / [ ] Mail
[ ] Hand Delivery
[ ] E-filed
[ ] Fax (Person agreed to service by fax.)
[ ] 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.)
Sign here ►
Date / Typed or Printed Name

Order on Petition for Name and Gender Change