Name
Address
City, State, Zip
Phone
Email
I am the [ ] Defendant
[ ] Attorney for the Defendant and my Utah Bar number is ______
In the Justice Court of Utah
______Judicial District ______County
Court Address ______
______
Plaintiff
v.
______
Defendant / Notice of Removal from District Court
______
Case Number
______
Judge

I say as follows:

(1) The plaintiff agrees to have this case tried in this court as a small claims case.

(2) This court has jurisdiction of this case because: (Choose all that apply.)

[ ] I reside in the jurisdiction of this court.

[ ] The events in this case happened in the jurisdiction of this court.

(3) I am notifying the court that this case is being removed to this court from the ______(name of court) district court.

By removing this case to justice court, I agree to using the simplified rules of procedure and evidence and waive my right to a jury trial in that court.

I have not included any non-public information in this document.
I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true.
Sign here ►
Date / Defendant or Attorney
Sign here ►
Date / Plaintiff or Attorney
Notice of Removal from District Court / Approved Board of Justice Court Judges May 13, 2011
Revisions Approved by Supreme Court July 18, 2016 / Page 2 of 2