1. family and parenting
2. children

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.
Plaintiff/Petitioner (First)
Defendant/Respondent (First)
Name
Name
Address
Address
City, State, Zip
City, State, Zip
Phone
Email
First Plaintiff/Petitioner’s Attorney*
Phone
Email
First Defendant/Respondent’s Attorney*
Name
Name
Bar Number
---------------------------------------------------------------------------------Plaintiff/Petitioner (Second)
Bar Number
---------------------------------------------------------------------------Defendant/Respondent (Second)
Name
Name
Address
Address
City, State, Zip
City, State, Zip
Phone
Email
Second Plaintiff/Petitioner’s Attorney*
Phone
Email
Second Defendant/Respondent’s Attorney*
Name
Name
Bar Number
Bar Number
*Attorney mailing and email addresses provided by
Utah State Bar.
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.)
PLEASE CHOOSE ONE BEFORE
PROCEEDING:
No monetary damages are requested/
Damages Unspecified (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)
 This case is exempt from URCP 26. (E)
— — MOTION TO RENEW JUDGMENT — —
$37.50  Damages $2000 or less
$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
$92.50  Damages $2001 - $9,999
Civil Cover Sheet
Revised May 17, 2013
Page 1
Choose  Only One Category
Case Type
Fee
Case Type
— — — — — APPEALS — — — — —
$100  Domestic Modification (T2)
$360  Administrative Agency Review
$100  Counter-petition: Domestic
Modification
Sch  Tax Court (Appeal of Tax Commission
$35

Foreign Domestic Decree (E)
Decision)
Court: Refer to Clerk of Court
$360  Grandparent Visitation (T2)
upon filing.
$360  Paternity/Parentage (T2)
$225  Civil (78A-2-301(1)(h)) (E)
$310  Separate Maintenance (T2)
$225  Small Claims Trial de Novo (E)
$35  Temporary Separation (E)
— — — — GENERAL CIVIL — — — —
$35  Uniform Child Custody Jurisdiction &
$360  Attorney Discipline (T2)
Enforcement Act (UCCJEA) (E)
Sch  Civil Rights
$35  Uniform Interstate Family Support Act
(UIFSA) (E)
$0  Civil Stalking (E)
— — — — — JUDGMENTS — — — — —
$360  Condemnation/Eminent Domain
$35  Foreign Judgment (Abstract of) (E)
Sch  Contract
$50  Abstract of Judgment/Order of Utah
Sch  Debt Collection
Court/Agency (E)
Sch  Eviction/Forcible Entry and Detainer
$30  Abstract of Judgment/Order of Utah
(E)
State Tax Commission (E)
$360  Extraordinary Relief/Writs
$35  Judgment by Confession (E)
$360  Forfeiture of Property (E)
— — — — — PROBATE — — — — —
Sch  Interpleader
$360  Adoption/Foreign Adoption (T2)
Sch  Lien/Mortgage Foreclosure
$8  Vital Statistics §26-2-25 per form
Sch  Malpractice
$360  Conservatorship (T2)
Sch  Miscellaneous Civil
$360  Estate Personal Rep – Formal (T2)
Sch  Personal Injury
$360  Estate Personal Rep – Informal (T2)
$360  Post Conviction Relief: Capital (E)
$35  Foreign Probate/Child Custody Doc.
(E)
$360  Post Conviction Relief: Non-capital (E)
$360

Gestational Agreement (T2)
Sch  Property Damage
$360  Guardianship (T2)
Sch  Property Rights
$0  Involuntary Commitment (T2)
Sch  Sexual Harassment
$360  Minor’s Settlement (T2)
Sch  Water Rights
$360  Name Change (T2)
Sch  Wrongful Death
$360  Supervised Administration (T2)
$360  Wrongful Lien
$360  Trusts (T2)
Sch  Wrongful Termination
$360  Unspecified (Other) Probate (T2)
— — — — — DOMESTIC — — — — —
— — — — SPECIAL MATTERS — — — —
$0  Cohabitant Abuse (E)
$35  Arbitration Award (E)
$310  Marriage Adjudication (Common Law)
$0  Determination Competency-Criminal
(T2)
$310  Custody/Visitation/ Support (T2)
(E)
$135

Expungement (E)
$310
Divorce/Annulment (T2)
$0  Hospital Lien (E)
Check if child support, custody or
$35  Judicial Approval of Document: Not
parent-time will be part of decree
Part of Pending Case (E)
 Check if Temporary Separation
$35  Notice of Deposition in Out-of-State
filed
Case/Foreign Subpoena (E)
$8  Vital Statistics §26-2-25 per form
$35  Open Sealed Record (E)
$115  Counterclaim: Divorce/Sep Maint.
(E) Exempt from URCP Rule 26
$115  Counterclaim: Custody/Visitation/
(T2) Case type defaults to Tier 2 (no monetary damages)
Support
$155  Counterclaim: Paternity/Grandparent
Visitation
Fee
~[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: 328-8849
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, SALT LAKE DEPARTMENT, STATE OF UTAH
____________________________________________________________________________
)
~[PETITIONER],
)
Petitioner,
)
VERIFIED COMPLAINT
vs.
FOR DIVORCE
)
~[RESPONDENT],
)
Civil No. ________________________
Respondent.
)
Judge ___________________________
)
Commissioner ____________________
____________________________________________________________________________
COMES NOW Petitioner, ~[Client] by and through counsel, ~[Attorney], Legal Aid
Society of Salt Lake and respectfully petitions for relief in this action against the Respondent and
in support thereof alleges as follows:
Provisions Relating to Jurisdiction
1.
Petitioner is a bona fide resident of Salt Lake County, State of Utah, and has been
for three months immediately prior to the filing of this action.
1.
Respondent is a bona fide resident of Salt Lake County, State of Utah, and has
been for three months immediately prior to the filing of this action.
1.
Both Petitioner and Respondent are bona fide residents of Salt Lake County, State
of Utah, and have been for three months immediately prior to the filing of this action.
2.
The parties resided in the marital relationship in the State of Utah or the acts
complained of by Petitioner were committed by Respondent in the State of Utah and therefore
this Court has long-arm jurisdiction over Respondent pursuant to Utah Code Ann. 78B-3-205.
3.
Petitioner and Respondent were married on ~[date], in ~[place] and are presently
married. The parties separated on or about ~[separation date].
Provisions Relating to Grounds
4.
During the course of the marriage the parties have experienced difficulties that
cannot be reconciled that have prevented the parties from pursuing a viable marriage
relationship.
4.
Other Grounds - {See Supervising Attorney}
4.
An Annulment should be granted pursuant to Utah Code Ann. 30-1-17 due to:
~Respondent/Petitioner having failed to obtain a divorce from a former spouse.
~the marriage being incestuous.
~Respondent being afflicted with a sexually transmitted disease.
~one or both parties being under the age of 18 years of age and failed to obtain
parental consent to marry.
~one or both parties being under the age of 14 years of age.
~the marriage being between persons of the same sex.
Therefore, this marriage should be declared null and void ab initio. In the alternative, a
divorce should be granted on the grounds of irreconcilable differences.
4.
An Annulment should be granted on common law grounds due to:
~Respondent's material misrepresentations to wit:
~the marriage not being consummated because:
Therefore, this marriage should be declared null and void ab initio. In the alternative, a
divorce should be granted on the grounds of irreconcilable differences.
Provisions Relating to the Children of the Parties
5.
There have been ~[number] children born as issue of this marriage to wit:
~[Children’s initials, month and year of birth, i.e. “SPR born October 1962”]
6.
Pursuant to Rule 100 Utah Rules of Civil Procedure, Petitioner states, upon
information and belief, that there are no proceedings for custody of the above-named minor
children filed or pending in the Juvenile Court.
The Uniform Child Custody Jurisdiction and Enforcement Act
7.
Utah has jurisdiction to make child custody and parent-time determinations
pursuant to Utah Code Ann. 78B-13-101 et seq. in that:
~a.
Utah is the home state of the minor children at the time of commencement
of this proceeding.
{Non Home State Alternatives}
~a.
Utah was the home state of the minor children within six months before
the commencement of this proceeding and the minor children are absent from this state but a
parent or person acting as parent continues to live in this state.
~a.
A court of another state does not have jurisdiction as home state of the
children or a court of the home state of the children has declined to exercise jurisdiction on the
ground that Utah is the more appropriate forum under Utah Code Ann. Section 78B-13-207 or
78B-13-208 and the children and the children’s parents, or the children and at least one parent or
a person acting as a parent have a significant connection with this state other than mere physical
presence; and substantial evidence is available in this state concerning the children’s care,
protection, training, and personal relationships.
b.
Pursuant to Utah Code Annotated 78B-13-209, said minor child currently
resides at: [current address]. The child has resided at the following places during the last five
years and with the following persons:
Note: Pursuant to Rule 4-202.09 of the Utah Rules of Judicial Administration, non-public
information, including child’s full name and street address of a non-party, has been omitted from
this document, but has been filed in Non-Public Information forms with the court.
[delete example provided]
Initials of Child
City, State & ZIP
where child lived
(not street address)
SPR
Mayberry, Utah 84111
Beginning and
ending dates
child lived at
that address
April 1, 2005 to
January 5, 2013
Name of person(s) with
whom child lived
Person’s current City,
State & ZIP
(not street address)
Ethel Merman
Oz, Utah 84111
Person’s
relationship to
child
Paternal
Grandmother
~c.
Petitioner has not participated, as a party or witness on in any other
capacity, in any other proceeding concerning the custody of or visitation/parent time with the
children.
*** [If Petitioner HAS been a party, use alternate paragraph:
Petitioner has participated in the following proceedings concerning the custody of or
visitation/parent time with the children: [name of action, type of action, name of court,
case number, judge and the date of the custody determination/order, if there is one, i.e.
Smith v. Jones, Order of Paternity, First Superior Court of Bliss County, State of Utopia,
Civil No. 014901234, Judge Tom Sawyer, presiding, Order entered May 1, 2004]. A copy of
said [name of order] is attached as Exhibit “”.
d.
Petitioner has no information of any proceedings that could affect the
current proceeding, including proceedings for enforcement and proceedings relating to domestic
violence, protective orders, termination of parental rights, and adoptions.
*** [If Petitioner HAS knowledge of proceedings use alternate paragraph:
d.
Petitioner knows of proceedings that could affect the current proceeding.
Petitioner is a party in [name of action, type of action, name of court, case number, judge
and the date of the custody determination/order, if there is one, i.e. Smith v. Jones, Order
of Paternity, First Superior Court of Bliss County, State of Utopia, Civil No. 014901234,
Judge Tom Sawyer, presiding, Order entered May 1, 2004]. A copy of said [petition or
order] is attached as Exhibit “”.
e.
Petitioner does not know of any person, not a party to these proceedings
who has physical custody of the children or who claims rights of legal custody or physical
custody of, or visitation with, the children.
*** [If Petitioner HAS knowledge of other persons, use alternate paragraph:
e.
Petitioner knows persons, not a party to these proceedings who have
physical custody of the children or who claim rights of legal custody or physical custody of,
or visitation with, the children. Their names and current addresses are:
Child Custody and Parent-time
8.
Petitioner should be awarded the sole physical and sole legal custody of the minor
children of the parties.
*** NOTE: A Parenting Plan is required for all complaints requesting any type of joint
custody – joint legal custody and joint physical custody. See U.C.A. 30-3-10.2 – 1.9
8.
Both parties should be awarded the joint legal custody of the minor children of the
parties, but ~[Petitioner/Respondent] should be awarded the primary physical custody of the
children pursuant to the Parenting Plan attached as Exhibit “ ”.
***Note: If choosing joint legal custody, specific rights should be enumerated, see U.C.A.
30-2-10.1 through 10.3. For example, the parties may agree to the advisory guidelines in
30-3-33
***Note: Joint legal custody can effect TANF eligibility, therefore, if client is on TANF, you
may want to pray for sole custody with enumerated rights to opposing party
8.
Both parties should be awarded joint legal custody and joint physical custody of
the minor children of the parties. The parties shall exercise physical custody of the minor
children pursuant to the Parenting Plan attached as Exhibit “ ”. ~[specify time sharing schedule]
*** Note: Pursuant to U.C.A. 78B-12-102(13) joint physical custody means the child stays
with each parent overnight for more than 30% of the year and both parents contribute to
the expenses of the child in addition to paying child support.
*** Note: Pursuant to U.C.A. 78B-12-208 child support is calculated differently if “noncustodial” parent has child 110-131 nights, and 131 or more nights.
9.
Respondent should be awarded rights of parent-time with the minor children of
the parties as follows:
Reasonable parent-time should be as the parties agree. If the parties do not agree to a parent-time
schedule, the following schedule shall be considered the minimum parent-time to which the noncustodial
parent and the child shall be entitled:
CHILDREN UNDER 5 MONTHS OF AGE:
Weekly: Six hours of parent-time per week, specified by the court or the noncustodial parent
preferably, divided into three parent-time periods and to take place in the custodial home,
established child care setting or other environment familiar to the child.
Holidays: Two hours on the holidays indicated on Holiday Schedule below, preferably in the
custodial home, established child care setting or other environment familiar to the child.
CHILDREN 5 MONTHS TO UNDER 9 MONTHS OF AGE:
Weekly: Nine hours of parent-time per week, specified by the court or the noncustodial parent
preferably, divided into three parent-time periods and to take place in the custodial home,
established child care setting or other environment familiar to the child.
Holidays: Two hours on the holidays indicated on Holiday Schedule below, preferably in the
custodial home, established child care setting or other environment familiar to the child.
CHILDREN 9 MONTHS TO UNDER 12 MONTHS OF AGE:
Weekly: One eight hour visit per week to be specified by the noncustodial parent or the court
and one three hour visit per week to be specified by the noncustodial parent or the court.
Holidays: Eight hours on the holidays indicated on Holiday Schedule below.
Telephone, Virtual:: Brief phone contact and other virtual parent-time, if the equipment is
reasonably available, with the noncustodial parent at least two times per week, provided that if
the parties cannot agree on whether the equipment is reasonably available, the court shall decide
whether the equipment for virtual parent-time is reasonably available, taking into consideration:
a. the best interests of the child;
b. each parent’s ability to handle any additional expenses for virtual parent-time; and
c. any other factors the court considers material.
CHILDREN 12 MONTHS TO UNDER 18 MONTHS OF AGE:
Weekly: One eight hour visit per alternating weekend to be specified by the noncustodial parent
or the court.
On opposite alternating weekends, from 6 p.m. on Friday until noon on Saturday; and
One three hour visit per week to be specified by the noncustodial parent or the court.
Holidays: Eight hours on the holidays indicated on Holiday Schedule below, and
Telephone, Virtual:: Brief phone contact and other virtual parent-time, if the equipment is
reasonably available, with the noncustodial parent at least two times per week, provided that if
the parties cannot agree on whether the equipment is reasonably available, the court shall decide
whether the equipment for virtual parent-time is reasonably available, taking into consideration:
a. the best interests of the child;
b. each parent’s ability to handle any additional expenses for virtual parent-time; and
c. any other factors the court considers material.
Virtual parent-time shall be at reasonable hours and for reasonable duration.
CHILDREN 18 MONTHS TO UNDER 3 YEARS OF AGE:
Midweek:
***[CHOOSE AND INSERT ONE OF THE FOLLOWING OPTIONS: THE FIRST
OPTION IS MORE RESTRICTIVE AND DESIGNATES TRANSFER LOCATION. THE
SECOND OPTION IS THE STATUTORY LANGUAGE GIVING OPPOSING PARTY
OPTION TO PICK UP CHILD EARLIER AT CAREGIVER]
One weekday evening between 5:30 p.m. and 8:30 p.m. to be specified by the noncustodial parent
or the court with transfer of the child to take place at __________________.
One weekday evening between 5:30 p.m. and 8:30 p.m. to be specified by the noncustodial parent
or the court; however, if the child is being cared for during the day outside his regular place of
residence, the noncustodial parent may, with advance notice to the custodial parent, pick up the
child from the caregiver at an earlier time and return him to the custodial parent by 8:30 p.m.
Alternate Weekends: Beginning on the first weekend after the entry of the decree and
continuing each year from 6 p.m. Friday until 7 p.m. Sunday.
Holidays: Holidays as specified on Holiday Schedule below.
Extended Parental-time: Two one-week periods, separated by at least four weeks, at the option
of the noncustodial parent;
a. one week shall be uninterrupted time for the noncustodial parent;
b. the remaining week shall be subject to parent-time for the custodial parent consistent
with these guidelines; and
c. the custodial parent shall have an identical one-week period of uninterrupted time for
vacation.
A parent shall notify the other parent at least 30 days in advance of extended parent-time or
vacation weeks.
Telephone, Virtual: Brief phone contact and virtual parent-time, if the equipment is reasonably
available, with the noncustodial parent at least two times per week, provided that if the parties
cannot agree on whether the equipment is reasonably available, the court shall decide whether the
equipment for virtual parent-time is reasonably available, taking into consideration:
a. the best interests of the child;
b. each parent’s ability to handle any additional expenses for virtual parent-time; and
c. any other factors the court considers material.
Virtual parent-time shall be at reasonable hours and for reasonable duration.
CHILDREN 3 YEARS TO UNDER 5 YEARS OF AGE:
Midweek:
***[CHOOSE AND INSERT ONE OF THE FOLLOWING OPTIONS: THE FIRST
OPTION IS MORE RESTRICTIVE AND DESIGNATES TRANSFER LOCATION. THE
SECOND OPTION IS THE STATUTORY LANGUAGE GIVING OPPOSING PARTY
OPTION TO PICK UP CHILD EARLIER AT CAREGIVER]
One weekday evening between 5:30 p.m. and 8:30 p.m. to be specified by the noncustodial parent
or the court with transfer of the child to take place at __________________.
One weekday evening between 5:30 p.m. and 8:30 p.m. to be specified by the noncustodial parent
or the court; however, if the child is being cared for during the day outside his regular place of
residence, the noncustodial parent may, with advance notice to the custodial parent, pick up the
child from the caregiver at an earlier time and return him to the custodial parent by 8:30 p.m.
Alternate Weekends: Beginning on the first weekend after the entry of the decree and
continuing each year, from 6 p.m. on Friday until 7 p.m. on Sunday.
Holiday Parent-time: Holidays as specified on Holiday Schedule below.
Extended Parent-time: Two two-week periods, separated by at least four weeks, at the option
of the noncustodial parent;
a. one two-week period shall be uninterrupted time for the noncustodial parent;
b. the remaining two-week period shall be subject to parent-time for the custodial parent
consistent to these guidelines; and
c. the custodial parent shall have an identical two-week period of uninterrupted time for
vacation.
A parent shall notify the other parent at least 30 days in advance of extended parent-time or
vacation weeks.
Telephone. Virtual: Brief phone contact and other virtual parent-time, if the equipment is
reasonably available, with the noncustodial parent at least two times per week, provided that if
the parties cannot agree on whether the equipment is reasonably available, the court shall decide
whether the equipment for virtual parent-time is reasonably available, taking into consideration:
a. the best interests of the child;
b. each parent’s ability to handle any additional expenses for virtual parent-time; and
c. any other factors the court considers material.
Virtual parent-time shall be at reasonable hours and for reasonable duration.
CHILDREN 5 YEARS TO 18 YEARS OF AGE:
Midweek:
***[CHOOSE AND INSERT ONE OF THE FOLLOWING FOUR OPTIONS]
One weekday evening to be specified by the noncustodial parent or the court, or Wednesday
evening if not specified, from 5:30 p.m. until 8:30 p.m. Once the election of the weekday
evening parent-time is made, it may not be changed except by mutual written agreement or court
order.
One weekday to be specified by the noncustodial parent or the court, or Wednesday if not
specified, from the time the child’s school is regularly dismissed until 8:30 p.m. Once the
election of the weekday parent-time is made, it may not be changed except by mutual written
agreement or court order.
One weekday evening to be specified by the noncustodial parent or the court, or Wednesday
evening if not specified, from 5:30 p.m. until 8:30 p.m. In addition, if school is not in session on
the elected parent-time day, from approximately 9 a.m., accommodating the custodial parent’s
work schedule, until 8:30 p.m. if the noncustodial parent is available to be with the child. Once
the election of the weekday parent-time is made, it may not be changed except by mutual written
agreement or court order.
One weekday to be specified by the noncustodial parent or the court, or Wednesday if not
specified, from the time the child’s school is regularly dismissed until 8:30 p.m. In addition, if
school is not in session on the elected parent-time day, from approximately 9 a.m.,
accommodating the custodial parent’s work schedule, until 8:30 p.m. if the noncustodial parent is
available to be with the child. Once the election of the weekday parent-time is made, it may not
be changed except by mutual written agreement or court order.
Alternating Weekends:
***[CHOOSE AND INSERT ONE OF THE FOLLOWING FIVE OPTIONS]
Beginning on the first weekend after the entry of the decree and continuing each year, from 6
p.m. on Friday until 7 p.m. on Sunday.
Beginning on the first weekend after the entry of the decree and continuing each year, from the
time the child’s school is regularly dismissed on Friday until 7 p.m. on Sunday.
Beginning on the first weekend after the entry of the decree and continuing each year, if school is
not in session on Friday from approximately 9 a.m. accommodating the custodial parent’s work
schedule, until 7 p.m. on Sunday, if the noncustodial parent is available to be with the child.
Beginning on the first weekend after the entry of the decree and continuing each year, from 6
p.m. on Friday until 7 p.m. on Sunday. In addition, if school is not in session on Friday from
approximately 9 a.m. accommodating the custodial parent’s work schedule, until 7 p.m. on
Sunday, if the noncustodial parent is available to be with the child.
Beginning on the first weekend after the entry of the decree and continuing each year, from the
time the child’s school is regularly dismissed on Friday until 7 p.m. on Sunday. In addition, if
school is not in session on Friday from approximately 9 a.m. accommodating the custodial
parent’s work schedule, until 7 p.m. on Sunday, if the noncustodial parent is available to be with
the child.
Weekends include any “snow” days, teacher development days or other days when school is not
scheduled and which are contiguous to the weekend period.
Transportation for Weekend Parent-time: A step-parent, grandparent, or other responsible
adult designated by the noncustodial parent, may pick up the child if the custodial parent is aware
of the identity of the individual, and the parent will be with the child by 7 p.m.
Elections Regarding Weekend Parent-time: Elections should be made by the noncustodial
parent at the time of the entry of the divorce decree or court order, and may be changed by mutual
agreement, court order, or by the noncustodial parent in the event of a change in the child’s
schedule.
Holiday Parent-time: as specified on Holiday Schedule below.
Extended Parent-time: Extended parent-time with the noncustodial parent may be up to four
consecutive weeks when school is not in session at the option of the noncustodial parent
including weekends normally exercised by the noncustodial parent, but not holidays;
a. two weeks shall be uninterrupted time for the noncustodial parent; and
b. the remaining two weeks shall be subject to parent-time for the custodial parent for
weekday parent-time but not weekends, except for a holiday to be exercised by the other
parent.
c. The custodial parent shall have an identical two-week period of uninterrupted time
when school is not in session for purposes of vacation.
Notification: both parents shall provide written notification of extended parent-time or vacation
weeks with the child at least 30 days prior to the end of the child's school year to the other
parent and if notification is not provided timely the complying parent may determine the schedule
for extended parent-time for the noncomplying parent.
Telephone Contact: shall be at reasonable hours and for a reasonable duration.
Virtual Parent-time: if the equipment is reasonably available, and the parents reside at least 100
miles apart, shall be at reasonable hours and for reasonable duration, provided that if the parties
cannot agree on whether the equipment is reasonably available, the court shall decide whether the
equipment for virtual parent-time is reasonably available, taking into consideration:
a. the best interests of the child;
b. each parent’s ability to handle any additional expenses for virtual parent-time; and
c. any other factors the court considers material.
ELECTIONS:
Any elections required to be made in accordance with parent-time by either parent shall be made
a part of the decree or final order.
HOLIDAY SCHEDULE FOR NONCUSTODIAL PARENTS







Other Included Days: Holidays include any “snow” days, teacher development days after the
children begin the school year, or other days when school is not scheduled, contiguous to the
holiday period and take precedence over the weekend parent-time.
Alternating Weekends: Changes may not be made in the regular rotation of the alternating
weekend parent-time schedule.
Birthdays take precedence over holidays and extended parent-time, except Mother’s Day and
Father’s Day. Birthdays do not take precedence over uninterrupted parent-time if the parent
exercising uninterrupted time takes the child away from that parent’s residence for the
uninterrupted extended parent-time.
School Attendance: If a holiday falls on a regular scheduled school day, the noncustodial parent
shall be responsible for the child’s attendance at school for that school day.
Lengthier Holiday Period: If a holiday (except Halloween) falls on a weekend or on a Friday or
Monday and the total holiday period extends beyond that time so that the child is free from school
and the parent is free from work, the noncustodial parent is entitled to this lengthier holiday
period.
Pick up Time: At the election of the noncustodial parent, parent-time over a scheduled holiday
weekend may begin from the time the child’s school is regularly dismissed at the beginning of the
holiday weekend until 7 p.m. on the last day of the holiday weekend, OR at the election of the
noncustodial parent, if school is not in session, parent-time over a scheduled holiday weekend
may begin at approximately 9 a.m., accommodating the custodial parent’s work schedule, the first
day of the holiday weekend until 7 p.m. on the last day of the holiday weekend, if the
noncustodial parent is available to be with the child unless the court directs the application of the
first option (non-custodial parent pick up the child from the time school is regularly dismissed).
Pick up Person: A step-parent, grandparent, or other responsible individual designated by the
noncustodial parent, may pick up the child if the custodial parent is aware of the identity of the
individual, and the parent will be with the child by 7 p.m.

Custodial Parent: The custodial parent is entitled to the “odd numbered years” holidays
designated in the schedule below in even years and the “even numbered years” holidays in odd
years so that each parent has an equal amount of holiday time with the child.
ODD NUMBERED YEARS
EVEN NUMBERED YEARS
Child’s Birthday: on the day before or after the
actual birthdate beginning at 3 p.m. until 9 p.m.; at
the discretion of the noncustodial parent, he may
take other siblings along for the birthday.
Martin Luther King Jr.: beginning 6 p.m. Friday
until Monday at 7 p.m. unless the holiday extends
for a lengthier period of time to which the
noncustodial parent is completely entitled.
Spring Break: beginning at 6 p.m. on the day
school lets out for the holiday until 7 p.m. on the
Sunday before school resumes.
Child’s Birthday: on actual birthdate beginning at
3 p.m. until 9 p.m.; at the discretion of the
noncustodial parent, he may take other siblings
along for the birthday.
President’s Day: beginning at 6 p.m. on Friday
until 7 p.m. on Monday unless the holiday extends
for a lengthier period of time to which the
noncustodial parent is completely entitled.
Memorial Day: beginning at 6 p.m. on Friday
until Monday at 7 p.m., unless the holiday extends
for a lengthier period of time to which the
noncustodial parent is completely entitled.
July 24th: beginning 6 p.m. the day before the
holiday until 11 p.m. or no later than 6 p.m. on the
day following the holiday, at the option of the
parent exercising the holiday.
Columbus Day: beginning at 6p.m. the day before
the holiday until 7 p.m. on the holiday.
July 4th: beginning 6 p.m. the day before the
holiday until 11 p.m. or no later than 6 p.m. on the
day following the holiday, at the option of the
parent exercising the holiday.
Labor Day: beginning 6 p.m. on Friday until
Monday at 7 p.m. unless the holiday extends for a
lengthier period of time to which the noncustodial
parent is completely entitled.
Fall School Break: if applicable, commonly
known as U.E.A. weekend beginning at 6 p.m. on
Wednesday until Sunday at 7 p.m. unless the
holiday extends for a lengthier period of time to
which the noncustodial parent is completely
entitled.
Veteran’s Day Holiday: beginning 6 p.m. the day
before the holiday until 7 p.m. on the holiday.
*Christmas School Vacation: the first portion of
the Christmas school vacation including Christmas
Halloween: on October 31 or the day Halloween
is traditionally celebrated in the local community
from after school until 9 p.m. if on a school day, or
from 4 p.m. until 9 p.m..
Thanksgiving Holiday: beginning Wednesday at
7 p.m. until Sunday at 7 p.m..
*Christmas School Vacation: the second portion
of Christmas school vacation beginning 1 p.m. on
Eve and Christmas day continuing until 1 p.m. on
the day halfway through the holiday period, if there
are an odd number of days for the holiday period,
or until 7 p.m. if there are an even number of days
for the holiday period, so long as the entire holiday
period is equally divided.
the day halfway through the holiday period, if there
are an odd number of days for the holiday period,
or at 7 p.m. if there are an even number of days for
the holiday period, so long as the entire Christmas
holiday period is equally divided.
*”Christmas School Vacation” means the time period beginning on the evening the child gets out of
school for the Christmas or winter school break until the evening before the child returns to school.
Father's Day: with natural or adoptive father every year beginning at 9 a.m. until 7 p.m. on the holiday.
Mother's Day: with natural or adoptive mother every year beginning at 9 a.m. until 7 p.m. on the holiday
9.
Respondent should be awarded supervised parent-time rights with the minor
children of the parties as follows: ~[specify schedule of parent-time and who the supervisor will
be] Supervised parent-time is requested for the following reasons: ~[specify]
~
Respondent should be restrained from using illegal drugs and alcohol immediately
before and during all periods of parent-time with the minor children.
~
Respondent should be restrained from removing the minor children from the State
of Utah without Petitioner’s written consent.
Provisions Relating to Support Payments
10.
Petitioner is employed at ~[place], earns $~[amount] per hour, works ~[number]
hours per week and therefore grosses $~[amount] per month.
10.
Petitioner is salaried and grosses $~[amount] per month.
10.
Petitioner is not employed and receives ~[amount] per month TANF.
10.
Petitioner is not employed and has no source of income. ~[state reason why]
10.
Petitioner is unemployed but is capable of working at a job which would pay
$~[amount] per hour based upon Petitioner's work experience as a ____________ during the
period of the parties' marriage and income should be attributed to Petitioner in the amount of
$~[amount] per month.
11.
Respondent is employed at ~[place], earns $~[amount] per hour, works
~[number] hours per week and therefore grosses $~[amount] per month.
11.
Respondent is salaried and grosses $~[amount] per month.
11.
Respondent is unemployed but is capable of working at [specify type of
employment] which would pay $~[amount] per hour based upon Respondent's work experience
as a ______________ during the period of the parties' marriage and income should be attributed
to Respondent in the amount of $~[amount] per month.
12.
Pursuant to Utah Code Ann. 78B-12-202 et seq. Respondent should be ordered to
pay child support to commence ~[specify month and year and reason i.e., the month of the
parties separation].
a.
The sum of $ per month as base support for the minor children of the parties
pursuant to the Uniform Child Support Guidelines until said children become 18 years of age, or
have graduated from high school during the children's normal and expected year of graduation,
whichever occurs later. (See child support worksheet attached as Exhibit “A”)
b.
The base child support award shall be reduced by (a) 50% for each child for time
periods during which a child is with the noncustodial parent by order of the court or by written
agreement of the parties for at least 25 of any 30 consecutive days of extended parent-time or (b)
25% for each child for time periods during which a child is with the noncustodial parent by order
of the court or by written agreement of the parties for at least 12 of any 30 consecutive days of
extended parent-time. If the dependent child is a recipient of Temporary Aid to Needy Families,
any agreement by the parties for reduction of child support during extended parent-time shall be
approved by the Office of Recovery Services. However, normal parent-time and holiday visits to
the custodial parent shall not be considered an interruption of the consecutive day requirement.
c.
The obligee (custodial parent) shall be entitled to immediate and automatic
income withholding relief pursuant to Utah Code Ann. 62A-11 Parts 4 and 5. This income
withholding procedure applies to existing and future payors, and all withheld income shall be
submitted to the Office of Recovery Services.
[Note: for cases where Petitioner is not on TANF with existing child support case,
the following may be added:] Until such time that income withholding is commenced by the
Office of Recovery Services, Respondent should make child support payments directly to
Petitioner.
d.
Pursuant to Utah Code Ann. 30-3-10.5, all monthly payments of child support,
maintenance or alimony provided in the order or decree shall be due on the first day of each
month, unless otherwise specified.
e.
All administrative fees and costs of income withholding assessed by the Office of
Recovery Services shall be paid by Respondent in addition to the base child support obligation.
f.
All child support payments should be made to the Office of Recovery Services,
P.O. Box 45011, Salt Lake City, UT 84145-0011, unless the Office of Recovery Services gives
notice that payments should be sent elsewhere.
g.
The issue of child support arrearages may be determined by further judicial or
administrative determination.
h.
Pursuant to Utah Code Ann. 78B-12-108 and 205 each parent’s child support
obligation shall be established in proportion to their adjusted gross incomes. The child support
obligation of the father shall be $. The child support obligation of the mother shall be $. (See
child support worksheet attached as Exhibit “A”) Except during periods of court-ordered parenttime, if physical custody of the children changes from that assumed in the original order, the
parent without physical custody shall be required to pay the amount of support set forth in this
paragraph without the need to modify this order to the parent who has physical custody, to a
relative to whom physical custody of the children has been voluntarily given, or to the state if the
children are in state custody.
i.
When a child becomes 18 years of age, or has graduated from high school during
the child’s normal and expected year of graduation, whichever occurs later, the base child
support award is automatically adjusted to reflect the base combined child support obligation
pursuant to the uniform child support guidelines for the remaining number of children due child
support, unless otherwise provided in the order. The income used for the purpose of adjusting
the support shall be the income of the parties at the time of the entry of the original order.
For Direct Payment of Child Support see U.C.A. 62A-11-502
c.
Pursuant to Utah Code Ann. 62A-11-502 the obligor parent (non-custodial
parent) shall make child support payments directly to the obligee parent (custodial parent)
as follows: ~[specify] Pursuant to Utah Code Ann. 30-3-10.5, unless otherwise specified, all
monthly payments of child support, maintenance or alimony provided in the order or
decree shall be due on the first day of each month. However, any party may subsequently
pursue income withholding through the Office of Recovery Services upon the date payment
of child support becomes delinquent, the obligor or obligee requests, or the date the court
or administrative body so modifies the order.
d.
In the event income withholding is commenced, all administrative fees and
costs of income withholding assessed by the Office of Recovery Services shall be paid by
Respondent in addition to the base child support obligation.
Provisions Relating to Health Insurance
13.
Pursuant to Utah Code Ann. 78B-12-212, if health insurance for the benefit of the
minor children is available to either party, that party should be required to maintain said
insurance.
a.
Both parties should share equally the out-of-pocket costs of the premium actually
paid by a parent for the children's portion of insurance. The children’s portion of the premium
shall be calculated by dividing the premium amount by the number of persons covered under the
policy and multiplying the result by the number of minor children of the parties in this case.
b.
Both parties should share equally all reasonable and necessary uninsured and
unreimbursed medical and dental expenses, including deductibles and co-payments, incurred for
the minor children and actually paid by the parties.
c.
The parent ordered to maintain insurance should provide verification of coverage
to the other parent, or to the Office of Recovery Services under Title IV of the Social Security
Act, upon initial enrollment of the dependent children, and thereafter on or before January 2, of
each calendar year. The parent should notify the other parent, or the Office of Recovery
Services, of any change of insurance carrier, premium, or benefits within 30 calendar days of the
date that parent first knew or should have known of the change.
d.
A parent who incurs medical expenses should provide written verification of the
cost and payment of medical expenses to the other parent within 30 days of payment.
e.
A parent incurring medical expenses may be denied the right to receive credit for
the expenses or to recover the other parent's share of the expenses if that parent fails to comply
with the Subparagraphs "c" and "d" above.
f.
The parent to whom written verification is provided should reimburse the parent
who incurred the medical expenses one-half of the amount of the out-of -pocket costs within 30
days of receipt of the written verification.
Provisions Relating to Child Care Expenses
14.
Pursuant to Utah Code Ann. 78B-12-214, both parties should share equally the
reasonable work-related or career or occupational training related child care expenses of the
custodial parent.
a.
The non-custodial parent should begin paying his or her share of child care
expenses on a monthly basis immediately upon presentation of proof of the child care expense.
b.
The parent who incurs child care expenses should provide written verification of
the cost and identity of a child care provider to the other parent upon initial engagement of a
provider and thereafter on the request of the other parent. The parent should notify the other
parent of any change of child care provider or the monthly expense of child care within 30
calendar days of the date of the change. A parent incurring child care expenses may be denied
the right to receive credit for the expenses or to recover the other parent's share of the expenses if
the parent incurring the expenses fails to comply with these provisions.
~/b.
The identity of the child care provider shall not be provided to the
noncustodial parent for the following reasons: ~[specify reasons]
c.
The parent to whom written verification is provided should reimburse the parent
who incurred the child care expenses one-half of the amount of the out-of -pocket costs within 30
days of receipt of the written verification.
Provisions Relating to Life Insurance
~[child support, no alimony options]
15.
Respondent currently has in force and effect a life insurance policy on
Respondent's life. Respondent should maintain in full force and effect said life insurance policy
until the child obligation herein terminates. During such period, Respondent should irrevocably
designate the parties’ minor children as beneficiaries on said life insurance, and designate
Petitioner as the trustee for said minor children.
15.
Respondent should obtain a life insurance policy on Respondent's life, so long as
such is available at reasonable cost or through Respondent's employer, in a face amount of
sufficient size to provide for a monthly income equal to child support payments herein.
Respondent should maintain in full force and effect said life insurance policy until the child
support obligation herein terminates. During such period, Respondent should irrevocably
designate the parties’ minor children as beneficiaries on said life insurance, and designate
Petitioner as the trustee for said minor children.
~[alimony options]
15.
Respondent currently has in force and effect a life insurance policy on
Respondent's life. Respondent should maintain in full force and effect said life insurance policy
until the child support and all other financial obligations herein terminate. During the period of
the children’s minority, Respondent should irrevocably designate the parties’ minor children as
beneficiaries on said life insurance, and designate Petitioner as the trustee for said minor
children. Thereafter, so long as the alimony obligation continues, Respondent should
irrevocably designate Petitioner as beneficiary on said life insurance.
15.
Respondent should obtain a life insurance policy on Respondent's life, so long as
such is available at reasonable cost or through Respondent's employer, in a face amount of
sufficient size to provide for a monthly income equal to child support and alimony payments
herein. Respondent should maintain in full force and effect said life insurance policy until the
support obligations herein terminate. During the period of the children’s minority, Respondent
should irrevocably designate the parties’ minor children as beneficiaries on said life insurance,
and designate Petitioner as the trustee for said minor children. Thereafter, so long as the alimony
obligation continues, Respondent should irrevocably designate Petitioner as beneficiary on said
life insurance.
Provisions Relating to Debts and Obligations
16.
The parties have no outstanding debts or obligations.
16.
Respondent should assume and pay, and hold Petitioner harmless from liability
on, all debts and obligations incurred by the parties prior to their date of separation, ~[separation
date]. Thereafter, all debts and obligations contracted by the parties should be the responsibility
of the party who incurred the particular debt. Pursuant to Utah Code Ann. 30-3-5(c)(ii) the
parties should notify respective creditors or obligees, regarding the division of debts, obligations,
or liabilities herein and the parties’ separate, current addresses.
16.
Respondent should assume and pay, and hold Petitioner harmless from liability
on, all debts and obligations incurred by the parties prior to their date of separation, ~[separation
date]. Thereafter, Respondent should assume and pay all debts and obligations incurred for a
family purpose ~[specify]. Otherwise, all debts and obligations contracted by the parties should
be the responsibility of the party who incurred the particular debt. Pursuant to Utah Code Ann.
30-3-5(c)(ii) the parties should notify respective creditors or obligees, regarding the division of
debts, obligations, or liabilities herein and the parties’ separate, current addresses.
16.
Respondent should assume and pay, and hold Petitioner harmless from liability
on, all debts and obligations incurred by the parties during their marriage, with the exception of
the following obligations which Petitioner should assume and pay. ~[list debts and amounts].
Pursuant to Utah Code Ann. 30-3-5(c)(ii) the parties should notify respective creditors or
obligees, regarding the division of debts, obligations, or liabilities herein and the parties’
separate, current addresses.
16.
Each party should assume and pay the following:
PETITIONER
RESPONDENT
a.
All remaining debts and obligations should be the responsibility of the party who
incurred the particular debt.
b.
Pursuant to Utah Code Ann. 30-3-5(c)(ii) the parties should notify respective
creditors or obligees, regarding the division of debts, obligations, or liabilities herein and the
parties’ separate, current addresses.
Provisions Relating to Personal Property
17.
During the course of the marriage relationship, the parties acquired certain items
of personal property. The parties should be awarded said property as they have heretofore
divided it.
17.
During the course of the marriage relationship, the parties have acquired certain
items of personal property. The parties should be awarded said property as follows:
PETITIONER
RESPONDENT
a.
All remaining personal property should be awarded to each of the parties as they
have heretofore divided it.
~b.
All property and all property rights which may be vested in either party as a
result of family inheritance, trusts, or similar sources should be awarded to the party from
whose family it came.
Provisions Relating to Real Property
18.
The parties acquired no real property during the course of this marriage, nor do
they presently own an interest in real property.
18.
During the course of the marriage, the parties acquired certain real property to
a.
A home located at ~[address, city, state], more particularly described as follows:
wit:
~[legal description must be included, get from County Recorder’s office or tax notice].
b.
Said real property should be sold as soon as reasonably practicable and the
proceeds of the sale should be applied as follows:
I.
First, pay expenses of sale;
ii.
Second, retire any and all mortgages and liens;
~iii.
Third, pay all marital debts and obligations;
iv.
Last, the balance remaining thereafter to be divided equally between the
parties.
c.
Both parties should execute any necessary documents for the listing and sale of
said real property. In the event the Respondent fails to execute said documents, Petitioner may
submit an ex parte motion, pursuant to Rule 70 of the Utah Rules of Civil Procedure, and the
Court may direct the clerk of the court to execute said necessary documents.
18.
During the course of the marriage, the parties acquired certain real property to
a.
A home located at ~[address, city, state], more particularly described as follows:
wit:
~[legal description must be included, get from County Recorder’s office or tax notice].
b.
Petitioner should be awarded the home and real property as Petitioner's sole and
exclusive property. Respondent should execute a quit claim deed within 10 days of the entry of
the Decree of Divorce herein. In the event the Respondent fails to execute a quit claim deed as
ordered, Petitioner may submit an ex parte motion, pursuant to Rule 70 of the Utah Rules of
Civil Procedure, and the Court may direct the clerk of the court to execute said quit claim deed.
18.
During the course of the marriage, the parties acquired certain real property to
a.
A home located at ~[address, city, state], more particularly described as follows:
wit:
~[legal description must be included, get from County Recorder’s office or tax notice].
b.
Petitioner should be awarded the home and real property as Petitioner's sole and
exclusive property and Respondent should be awarded an equitable lien in said property
~in the amount of $ [amount] (calculate using appraisal, valuation on tax notice, or
comparative market analysis {obtained from realtor})
~in an amount equal to one-half of the net equity accrued by the parties as of the date of
the entry of the Decree of Divorce herein. The net equity existing at the date of the entry of
the Decree of Divorce should be determined by the value of the property as determined by
~an independent appraisal/valuation of tax notice/comparative market analysis and
deducting the amount of all encumbrances at the date of the entry of the Decree of Divorce
from the determined value.
c.
Respondent should execute a quit claim deed within 10 days of the entry of the
Decree of Divorce herein. In the event the Respondent fails to execute a quit claim deed as
ordered, Petitioner may submit an ex parte motion, pursuant to Rule 70 of the Utah Rules of
Civil Procedure, and the Court may direct the clerk of the court to execute said quit claim deed.
18.
During the course of the marriage, the parties acquired certain real property to
a.
A home located at ~[address, city, state], more particularly described as follows:
wit:
~[legal description must be included, get from County Recorder’s office or tax notice].
b.
Petitioner should be awarded the exclusive use and possession of the parties'
home until the occurrence of the first of the following conditions:
I.
The children of the parties reach eighteen (18) years of age, marries, or
otherwise become emancipated;
ii.
Petitioner remarries;
iii.
Petitioner ceases to use the home as the primary residence;
iv.
Petitioner cohabits with a non-relative adult of the opposite sex in the
home.
c.
Upon the occurrence of the first of the conditions enumerated above, the
Respondent should receive one-half of the net equity existing at the date of the entry of the
Decree of Divorce herein in said home. Petitioner should be awarded all equity in excess of the
Respondent's aforementioned share of equity in said home existing at the time of the entry of the
Decree in this matter.
d.
The net equity existing at the date of the entry of the Decree of Divorce should be
determined by the value of the property as determined by ~an independent appraisal/valuation
of tax notice/comparative market analysis and deducting the amount of all encumbrances at
the date of the entry of the Decree of Divorce from the determined value.
e.
The Respondent should execute a Quit Claim Deed for said property in favor of
Petitioner the within 10 days of the entry of the Decree of Divorce herein. In the event the
Respondent fails to execute a quit claim deed as ordered, Petitioner may submit an ex parte
motion, pursuant to Rule 70 of the Utah Rules of Civil Procedure, and the Court may direct the
clerk of the court to execute said quit claim deed.
~f.
During the course of the marriage, the parties acquired other real property to wit:
I.
~[location and legal description].
ii.
Said real property should be awarded to the parties as follows: ~[specify]
18.
Respondent owned/was purchasing a home prior to the parties’ marriage to wit:
a.
A home located at ~[address, city, state], more particularly described as follows:
~[legal description must be included, get from County Recorder’s office or tax notice].
SEE ATTORNEY REGARDING THIS SITUATION!
Provisions Relating to Alimony
19.
Neither party should be awarded alimony.
19.
Each party is fully capable of supporting themselves and, therefore, neither party
should be awarded alimony at the present time.
19.
Pursuant to Utah Code Ann. 30-3-5, Petitioner should be awarded a sum of
$~[amount-alimony] per month as alimony from Respondent for a period ~[specify, i.e. “equal
to the length of the marriage” “of ____ years/months”]. Petitioner and Respondent were
married ~[date].
a.
The financial condition and needs of the Petitioner include the following.
Petitioner has monthly expenses totaling $[amount] which are more fully described in Exhibit
“B” attached hereto and incorporated by reference. ~[use other supporting facts and
documents such as utility bills, receipts, etc.]
b.
Petitioner has earning capacity or ability to produce income including the
following: ~[specify, including current income with tax deductions, child support as
requested, income history, inability to earn and reasons, i.e. disabled or providing full time
care for children under school age, etc.] ~[attach supporting Exhibits]
c.
Petitioner has need of monthly financial support in the amount of $[difference of
need and monthly income].
d.
Respondent has an ability to provide support to Petitioner as requested herein.
Respondent is presently employed and earns $~[amount] per month. ~and has the following
income earning assets:
~ e.
Payment of alimony to Petitioner by Respondent will restore Petitioner to (insert
one of the following)
~
the standard of living that existed at the time of the parties’ separation.
~
the standard of living that exists at the time of trial. (discretion of court)
~
the standard of living that existed at the time of the marriage. (marriages
of short duration with no children)
~
the condition which existed at the time of the marriage. (marriages of
short duration with no children)
~ e.
Payment of alimony to Petitioner by Respondent will equalize the parties’
respective standards of living. (long term marriages)
~ e.
Payment of alimony to Petitioner by Respondent will compensate Petitioner for
the enhancement of the Respondent’s earning capability by the efforts of both parties
during the parties’ marriage.
~ e.
The following major change in Respondent’s income due to the collective efforts
of both parties should be considered in determining the amount of alimony: ~[specify]
(marriage of long duration dissolves on threshold of major change in income due to
the efforts of both)
~[Use the following only in extreme cases:]
~ f.
In awarding alimony to the Petitioner, the Court should consider the fault of the
Respondent which led to and\or caused the parties irreconcilable differences.
~[describe].
~g.
Unless the Decree of Divorce specifically provides otherwise, the order of
alimony automatically terminates upon the remarriage of the spouse receiving alimony or the
establishment by the paying spouse that the receiving spouse is cohabiting with another person.
Provisions Relating to Pension and Related Assets
20.
The parties have acquired no interest in any pension or profit sharing plan during
the course of the marriage.
20.
Respondent has pension and/or profit sharing plans or other retirement benefits
through Respondent's place of employment. Petitioner should be awarded one-half of all
benefits accrued pursuant to such plans during the period of the parties’ marriage from the date
of marriage until the date of the entry of the Decree of Divorce herein.
Miscellaneous Provisions
Restraining Order
21.
Respondent should be permanently restrained from bothering, harassing,
annoying, threatening, or harming Petitioner at Petitioner's place of residence, employment or
any other place.
21.
Respondent has physically abused or threatened physical abuse to Petitioner as
follows: ~[state date and describe incident]. Such conduct by the Respondent constitutes a
threat of immediate harm to Petitioner. Therefore, Respondent should be restrained from
bothering, harassing, annoying, threatening, or harming the Petitioner at Petitioner's place of
residence, employment or any other place and the following order should be entered:
THE SALT LAKE CITY POLICE, SALT LAKE COUNTY SHERIFF,
CONSTABLE OR OTHER APPROPRIATE PEACE OFFICER SHOULD BE
DIRECTED TO RENDER ANY NECESSARY ASSISTANCE TO THE
PETITIONER. FURTHER, VIOLATION OF ANY OF THE PROVISIONS
MENTIONED HEREIN SHOULD BE DEEMED CONTEMPTUOUS, AND
THE RESPONDENT SHOULD BE PUNISHED ACCORDINGLY.
Taxes
22.
Petitioner should be entitled to claim the parties' minor children as exemptions for
the purposes of filing federal and state income tax returns. ~[Chose this only if the Petitioner
can realize a tax benefit]
22.
Providing that Respondent is current in all child support obligations herein and
current in all other financial obligations herein, Respondent should be entitled to claim the
parties' minor children as exemptions for the purposes of filing federal and state income tax
returns. If Respondent is not current in said obligations, Petitioner should be entitled to claim the
parties’ minor children as exemptions for the purposes of filing federal and state income tax
returns.
22.
Petitioner should be entitled to claim the following minor children as exemptions
for the purposes of filing federal and state income tax returns: ~[specify children’s initials,
month and year of birth, i.e. “SPR born October 1962”]. Providing that Respondent is
current in all child support obligations herein and current in all other financial obligations herein,
Respondent should be entitled to claim the following minor children as exemptions for the
purposes of filing federal and state income tax returns: ~[specify children’s initials, month and
year of birth, i.e. “SPR born October 1962”].
22.
Providing that Respondent is current in all child support obligations herein and
current in all other financial obligations herein and Petitioner is unable to utilize the deduction in
Petitioner's tax return, Respondent should be entitled to claim the parties' minor children as
exemptions for the purposes of filing federal and state income tax returns.
~[for odd-numbered children]:
22.
Petitioner should be entitled to claim the following minor children exemptions for
the purposes of filing federal and state income tax returns: ~[specify children’s initials, month
and year of birth, i.e. “SPR born October 1962”]. Providing that Respondent is current in all
child support obligations herein and current in all other financial obligations herein, Respondent
should be entitled to claim the following minor children exemptions for the purposes of filing
federal and state income tax returns: ~[specify children’s initials, month and year of birth, i.e.
“SPR born October 1962”]. At such time that there is only one remaining minor child which
can be claimed as an exemption, the parties should claim said child ~[specify children’s initials,
month and year of birth, i.e. “SPR born October 1962”] on alternate years with Petitioner
claiming said child in ~[odd or even] years.
BUY-OUT OPTION: (can be added to any provision where Petitioner is awarded
deduction)
Respondent should have the option to purchase said exemptions from Petitioner as follows: By
March 1st of each year, the parties will determine the amount of tax savings Petitioner would
realize from claiming said exemptions. Respondent will then have the option to purchase from
Petitioner the right to claim the exemptions for an amount equal to Petitioner’s projected savings.
If Respondent chooses to exercise this option, Respondent should tender payment, in full, to
Petitioner by April 5th of that year. Upon said payment, Petitioner should execute any necessary
tax forms to enable Respondent to claim said exemptions.
23.
In the event Petitioner and Respondent file a joint income tax return for the year
~[year], any income tax refund received for said year should be divided equally between the
parties.
Attorney's Fees
24.
Each party should be ordered to assume his/her own costs and attorney's fees
incurred in prosecuting this action.
24.
Respondent should be ordered to pay Petitioner's attorney's fees and Petitioner be
awarded judgment against Respondent for attorney’s fees in the amount of $600.00 if this matter
is uncontested. In the event that the matter is contested, Respondent should pay an additional
reasonable sum as may be deemed appropriate.
Other
~[#].
Petitioner should be restored the use of her former name, ~[NAME IN CAPS
AND BOLD] if she so desires.
~[#].
Petitioner has received public assistance from the State, and has assigned the right
to collect child support accrued during the time public assistance was received to the State of
Utah. Therefore, pursuant to Utah Code Ann. 78B-12-113, the State of Utah should be joined as
a party in interest in the above-entitled cause of action.
~[#].
Each party should be ordered to execute and deliver to the other such documents
as are required to implement the provisions of the Decree of Divorce entered by the Court.
~[#].
The Court should grant such other and further relief as it may deem just and
appropriate in this matter.
WHEREFORE, Petitioner prays that a Decree of Divorce be granted pursuant to the
terms set forth in this Complaint.
DATED this _____ day of ______________________________, 2013.
LEGAL AID SOCIETY OF SALT LAKE
___________________________________
~[Attorney]
Attorney for Petitioner
Pursuant to Rule 4-202.09 of the Utah Rules of Judicial Administration, the above-signed
declares that non-public information has been omitted and/or redacted from this document.
STATE OF UTAH
County of Salt Lake
)
: ss.
)
~[Client] (Affiant), being first duly sworn and under oath, deposes and says that Affiant
is the Petitioner in the above-entitled action; that Affiant has read the foregoing Complaint, and
understands the contents thereof, and the same is true of Affiant's own knowledge, information
and belief.
___________________________________
~[Client]
SUBSCRIBED AND SWORN TO before me this _____ day of ______________, 2013.
___________________________________
NOTARY PUBLIC
Residing in Salt Lake County
EXHIBIT #B
STATEMENT OF MONTHLY EXPENSES:
Rent or Mortgage:
$
Real Property Taxes:
$
Real Property Insurance:
$
Maintenance for Residence:
Food and Household Supplies:
$
$
Utilities such as Water, Electricity and Gas:
Telephone:
Laundry and Cleaning:
$
$
$
Clothing:
Medical:
$
$
Dental:
Insurance (other than automobile):
$
$
Child Care:
Child Support from Previous Marriages:
School:
$
$
$
Entertainment:
Incidentals (alcohol, tobacco, grooming, etc...):
$
$
Transportation (other than automobile):
Auto Expense (gasoline, repairs, insurance):
Auto Payments:
$
$
$
Installment Payments (please specify):
$
Other Expenses (please specify):
$
************************************************************
*************
TOTAL:
$
~[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: 328-8849
Person Served:_______________________
Date Served:__________ Time _________
___________________________________
Served by:__________________________
Documents Served:___________________
___________________________________
___________________________________
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, SALT LAKE DEPARTMENT, STATE OF UTAH
____________________________________________________________________________
)
~[PETITIONER],
)
Petitioner,
)
SUMMONS
vs.
)
~[RESPONDENT],
)
Civil No. ________________________
Respondent.
)
Judge ___________________________
)
Commissioner ____________________
____________________________________________________________________________
THE STATE OF UTAH TO THE RESPONDENT:
You are hereby summoned and required to file an Answer in writing to the attached Complaint
with the Clerk of the above-entitled Court at the Scott M. Matheson Courthouse located at 450
South State Street, Salt Lake City, Utah 84111, and to serve upon, or mail to the Petitioner's
attorney, at 205 NORTH 400 WEST, Salt Lake City, Utah 84103, a copy of said Answer, within
20 days if you are served in the State of Utah or within 30 days if you are served outside the
State of Utah, after service of this Summons upon you. If you fail to do so, judgment by default
will be taken against you for the relief demanded in said Complaint, which has been filed with
the Clerk of the above-entitled Court and a copy of which is hereto annexed and herewith served
upon you. READ THESE PAPERS CAREFULLY. These papers mean that you are being sued
for divorce.
DATED this _____ day of ________________________, 2013.
LEGAL AID SOCIETY OF SALT LAKE
_________________________________
~[Attorney]
Attorney for Petitioner
Serve Respondent at:
~[specify whether the address is residence, work(state name of employer), etc]
[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: 328-8849
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, SALT LAKE DEPARTMENT, STATE OF UTAH
____________________________________________________________________________
)
~[PETITIONER],
)
Petitioner,
NOTICE OF MANDATORY
)
DIVORCE ORIENTATION COURSE
vs.
)
~[RESPONDENT],
)
Civil No. ____________________
Respondent.
)
Judge _______________________
)
Commissioner ________________
____________________________________________________________________________
TO THE ABOVE NAMED PARTIES, PLEASE TAKE NOTICE:
1.
Pursuant to Utah Code Ann. 30-3-11.4, all parties with minor children in a
divorce or temporary separation case are required to attend a one-hour Mandatory Divorce
Orientation Course.
2.
The above-named Petitioner is required to attend the course no more than 60 days
after filing a petition for divorce.
3.
The above-named Respondent is required to attend the course no more than 30
days after being served with a petition for divorce.
4.
Both parties must attend the Mandatory Divorce Orientation Course before a
divorce decree may be entered unless waived by the court. A certificate of completion
constitutes evidence to the court of course completion by the parties.
5.
Failure to attend this course within the stated times may require your appearance
in court and Legal Aid Society of Salt Lake will seek judgment against you for attorney's fees in
the amount of not less than $300.00.
6.
The course will be offered at several different locations and times. The fee for the
course is $20.00 per person. If you feel you cannot afford to pay, you can ask the clerk at the
number below about what steps to follow.
INFORMATION ABOUT THE COURSE INCLUDING DATES, TIMES AND LOCATIONS
CAN BE FOUND ON THE COURT’S WEBSITE AT: www.utcourts.gov/specproj/dived.htm.
PLEASE CALL (801) 238-7180 TO FIND OUT MORE ABOUT THE COURSE AND TO
SCHEDULE A TIME TO ATTEND.
DATED this _________day of __________________________, 2013.
LEGAL AID SOCIETY OF SALT LAKE
_____________________________
~[Attorney]
Attorney at Law
Notice of “Mandatory Divorce Orientation Course”
Dear Client,
Please take notice that all parties with minor children in divorce cases are required to attend a
one-hour “Mandatory Divorce Orientation Course”. The divorce orientation course is
neutral, unbiased and include the following topics:
(a) options available as alternatives to divorce;
(b) resources available from courts and administrative agencies for resolving custody
and support issues without filing for divorce;
(c) resources available to improve or strengthen the marriage;
(d) a discussion of the positive and negative consequences of divorce;
(e) a discussion of the process of divorce;
(f) options available for proceeding with a divorce, including:
(i) mediation;
(ii) collaborative law; and
(iii) litigation; and
(g) a discussion of post-divorce resources.
The course may be provided in conjunction with the “Mandatory Educational Course for
Divorcing Parents” (a two-hour course) required by Utah Code Ann. 30-3-11.3 .
In order to fulfill this requirement you must follow the instructions below:
1.
Call 238-7180 to schedule a time to attend and to find out more about the course.
Information about the course including dates, times and locations may also be found on the
court’s website at: www.utcourts.gov/specproj/dived.htm.
2.
The fee for the course is $20.00. You can have the fee waived by presenting a
copy of the MOTION AND AFFIDAVIT FOR WAIVER OF COURT FEES drafted by this
office.
3.
When you attend the scheduled class, you must present a PICTURE
IDENTIFICATION or you will not be given credit for the class.
4.
After the class you will receive a CERTIFICATE OF COMPLETION. You must
return the certificate to your attorney in order to be given credit for attendance.
~[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: 328-8849
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, SALT LAKE DEPARTMENT, STATE OF UTAH
____________________________________________________________________________
)
~[PETITIONER],
)
Petitioner,
NOTICE OF MANDATORY
)
EDUCATIONAL COURSE FOR
vs.
DIVORCING PARENTS
)
~[RESPONDENT],
)
Civil No. ____________________
Respondent.
)
Judge _______________________
)
Commissioner ________________
____________________________________________________________________________
TO THE ABOVE NAMED PARTIES, PLEASE TAKE NOTICE:
1.
Pursuant to Utah Code Ann. 30-3-11.3, you are required to attend a two-hour
course entitled "Mandatory Educational Course for Divorcing Parents." The mandatory course is
designed to educate and sensitize divorcing parties to their children’s needs both during and after
the divorce process.
2.
Both parties must attend the “Mandatory Educational Course for Divorcing
Parents” before a divorce decree may be entered unless waived by the court. A certificate of
completion constitutes evidence to the court of course completion by the parties.
3.
Failure to attend this course may require your appearance in court and Legal Aid
Society of Salt Lake will seek judgment against you for attorney's fees in the amount of not less
than $300.00.
4.
The course will be offered at several different locations and times. The fee for the
course is $35.00 per person. If you feel you cannot afford to pay, you can ask the clerk at the
number below about what steps to follow.
INFORMATION ABOUT THE COURSE INCLUDING DATES, TIMES AND LOCATIONS
CAN BE FOUND ON THE COURT’S WEBSITE AT: www.utcourts.gov/specproj/dived.htm.
PLEASE CALL (801) 238-7180 TO FIND OUT MORE ABOUT THE COURSE AND TO
SCHEDULE A TIME TO ATTEND.
DATED this _________day of __________________________, 2013.
LEGAL AID SOCIETY OF SALT LAKE
_____________________________
~[Attorney]
Attorney at Law
Notice of “Mandatory Educational Course for Divorcing Parents”
Dear Client,
Please take notice that all parties who have minor children are required to attend a two-hour
course entitled “Mandatory Educational Course for Divorcing Parents.” The mandatory
course is designed to educate and sensitize divorcing parties to their children’s needs both during
and after the divorce process.
The course may be provided in conjunction with the “Divorce Orientation Course” (a one-hour
course) required by Utah Code Ann. 30-3-11.3 .
In order to fulfill this requirement you must follow the instructions below:
1.
Call 238-7180 to schedule a time to attend and to find out more about the course.
Information about the course including dates, times and locations may also be found on the
court’s website at: www.utcourts.gov/specproj/dived.htm.
2.
The fee for the course is $35.00. You MAY have the fee waived by presenting a
copy of the MOTION AND AFFIDAVIT FOR WAIVER OF COURT FEES drafted by this
office.
3.
When you attend the scheduled class, you must present a PICTURE
IDENTIFICATION or you will not be given credit for the class.
4.
After the class you will receive a CERTIFICATE OF COMPLETION. You must
return the certificate to your attorney in order to be given credit for attendance.
~[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: 328-8849
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, SALT LAKE DEPARTMENT, STATE OF UTAH
____________________________________________________________________________
)
~[PETITIONER],
)
Petitioner,
NOTICE OF MANDATORY
)
DIVORCE MEDIATION PROGRAM
vs.
)
~[RESPONDENT],
)
Civil No. _________________________
Respondent.
)
Judge ____________________________
)
Commissioner ______________________
____________________________________________________________________________
TO THE ABOVE-NAMED RESPONDENT, pursuant to Utah Code Ann. 30-3-39,
please take notice of the attached information and requirements regarding mandatory divorce
mediation program to help reduce the time and tensions associated with obtaining a divorce. If
after the filing of an answer to a complaint for divorce, there are any remaining contested issues,
the parties shall participate in good faith in at least one session of mediation, unless excused by
the court, mediator or director of dispute resolution programs for the courts for good cause. This
requirement does not preclude the entry of temporary orders.
DATED this _____ day of _______________________, 2013.
LEGAL AID SOCIETY OF SALT LAKE
___________________________________
~[Attorney]
Attorney for Petitioner
Summary of Divorce Mediation Program
1.
Beginning May 2005, if after the filing of an answer to a complaint for divorce,
there are any remaining contested issues, the parties shall participate in good faith in at least one
session of mediation.
2.
This requirement does not preclude the entry of pretrial (temporary) orders before
mediation takes place.
3.
The parties shall use a mediator qualified to mediate domestic disputes under
criteria established by the Judicial Council in accordance with Utah Code Ann. Section 78-31b5. A list of qualified mediators is available on the court’s website at
http://www.utcourts.gov/mediation/roster/index.asp.
4.
Unless otherwise ordered by the court or the parties agree upon a different
payment arrangement, the cost of mediation shall be divided equally between the parties.
5.
This requirement is mandatory. The directory of dispute resolution programs for
the courts, the court, or the mediatory may excuse either party from the requirement to mediate
for good cause.
6.
Mediation shall be conducted in accordance with the Utah Rules of Court-
Annexed Alternative Dispute Resolution. Found in Utah Code Ann. 38-31b-1 et. seq.
~[do no use mailing cert. if sending out with service packet]
CERTIFICATE OF MAILING
On this _____ day of ________________________, 2013, I deposited in the United
States Mail, postage prepaid, a true and correct copy of the foregoing Notice of Mandatory
Divorce Mediation Program, to the following:
~[Opposing party/attorney and address]
___________________________________
~[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: 328-8849
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, SALT LAKE DEPARTMENT, STATE OF UTAH
____________________________________________________________________________
)
~[PETITIONER],
)
Petitioner,
NOTICE OF RULE 26.1 DISCLOSURE
)
AND DISCOVERY IN DOMESTIC
vs.
RELATIONS ACTIONS
)
~[RESPONDENT],
)
Civil No. _________________________
Respondent.
)
Judge ____________________________
)
Commissioner ______________________
____________________________________________________________________________
TO THE ABOVE-NAMED RESPONDENT, please take notice that:
1. You are required by Utah Rule of Civil Procedure 26.1 to disclose to the petitioner the
following documents. The disclosure requirements apply to divorce, temporary separation,
separate maintenance, parentage, child custody, child support, and modification actions.
(a) Financial Declaration and required attachments. (The court-approved Financial
Declaration form is available at: www.utcourts.gov/selfhelp/ and a copy is attached for
your convenience)
(b) For every item and amount you list in the Financial Declaration, excluding monthly
expenses, attach copies of statements that are reasonably available to you verifying the
amounts.
(c) For the two tax years before the petition in this action was filed, attach complete federal
and state income tax returns, including Form W-2 and supporting tax schedules and
attachments, filed by you or on your behalf or on behalf of any entity in which you have a
majority or controlling interest, including, but not limited to, Form 1099 and Form K-1.
(d) Pay stubs and other evidence of all earned and un-earned income for the 12 months
before the petition in this action was filed.
(e) All loan applications and financial statements you prepared or used within the 12 months
before the petition in this action was filed.
(f) Documents verifying the value of all real estate in which you have an interest, including,
but not limited to, the most recent appraisal, tax valuation and refinance documents.
(g) All statements for the 3 months before the petition was filed for all financial accounts,
including, but not limited to, checking, savings, money market funds, certificates of
deposit, brokerage, investment, retirement, regardless of whether the account has been
closed, including those held in your name, jointly with another person or entity, or as a
trustee or guardian, or in someone else’s name on your behalf.
(h) If any of these documents are not reasonably available or are in the other party’s
possession, estimate the amounts entered on the Financial Declaration and explain the
basis for the estimation and why the documents are not available.
2.
You must disclose your completed Financial Declaration with all required
attachments to the petitioner within 28 days after the petitioner’s first disclosure or 28 days after
your appearance in this case, whichever is later. The petitioner’s first disclosure to you of the
documents required by URCP 26.1 must be within 14 days after service of your first answer to
the petition.
3.
Failure to fully disclose all assets and income in the Financial Declaration and
attachments may subject the non-disclosing party to sanctions under URCP 37. Sanctions may
include an award of non-disclosed assets to the other party, attorney’s fees or other
sanctions deemed appropriate by the court.
4.
Failure of a party to comply with URCP 26.1 does not preclude any other party
from obtaining a default judgment, proceeding with the case, or seeking other relief from the
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.
DATED this _____ day of ____________________________, 2013.
LEGAL AID SOCIETY OF SALT LAKE
___________________________________
~[Attorney]
Attorney for Petitioner
~[do no use mailing cert. if sending out with service packet]
CERTIFICATE OF MAILING
On this _____ day of _______________________, 2013, I deposited in the United States
Mail, postage prepaid, a true and correct copy of the foregoing Notice of Rule 26.1 Disclosure
and Discovery in Domestic Relations Actions, to the following:
~[Opposing party/attorney and address]
___________________________________
~[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: 328-8849
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, SALT LAKE DEPARTMENT, STATE OF UTAH
____________________________________________________________________________
)
~[PETITIONER],
)
Petitioner,
CERTIFICATE OF SERVICE OF
FINANCIAL DECLARATION AND
)
RULE 26 AND 26.1 DISCLOSURES
vs.
)
~[RESPONDENT],
)
Civil No. ________________________
Respondent.
)
Judge ___________________________
)
Commissioner ____________________
____________________________________________________________________________
Petitioner, by and through counsel, ~[Attorney], LEGAL AID SOCIETY OF SALT LAKE,
pursuant to the requirements of the Utah Rules of Civil Procedure 26 and 26.1, hereby certifies
that a true and correct copy of a court-approved Financial Declaration was served on Respondent
and that the Rule 26 and 26.1 Disclosures are contained herein.
RULE 26 DISCLOSURES
Individuals likely to have discoverable information
Name:
Address:
Telephone Number:
Subject of information:
Name:
Address:
Telephone Number:
Subject of information:
Fact Witnesses
Name:
Address:
Telephone Number:
Summary of expected testimony:
Name:
Address:
Telephone Number:
Summary of expected testimony:
Expert Testimony
Name:
Qualifications:
Publications 10 years:
Cases testified 4 years:
Summary of opinion:
Data relied on by expert:
Compensation to expert:
RULE 26.1 DISCLOSURES
Court-approved Financial Declaration and required attachments are attached hereto.
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.
DATED this _____ day of ____________________________, 2011.
LEGAL AID SOCIETY OF SALT LAKE
___________________________________
~[Attorney]
Attorney for Petitioner
CERTIFICATE OF MAILING
On this _____ day of _______________________, 2011, I deposited in the United States
Mail, postage prepaid, a true and correct copy of the foregoing Certification of Service of
Financial Declaration and Rule 26 and 26.1 Disclosures to the following:
~[Opposing party/attorney and address]
___________________________________
LEGAL AID
REPRESENTATION AGREEMENT AND ASSIGNMENT
I, ______________________(print name), in consideration of LEGAL AID SOCIETY
OF SALT LAKE (hereinafter Legal Aid) providing legal representation to me in a domestic
relations case, having read and understood the terms below and being under no duress, agree to
the following terms:
1.
I grant Legal Aid full power and authority to act on my behalf in this matter as
fully as I could do personally in my domestic relations case. I further ratify and confirm all such
acts that Legal Aid shall do or cause to be done by virtue of this grant of authority.
2.
I understand that Legal Aid is a non-profit organization and is providing
representation in my case on a flat fee basis subject to the terms contained in this Representation
Agreement. I also understand that I will be responsible for any court assessed fees, services fees
or other costs incurred in the prosecution of my case.
3.
I agree to fully cooperate with Legal Aid in the prosecution of my case. I will
keep Legal Aid informed of my current address and telephone number(s) as well as a person who
always get in contact with me. I will promptly advise Legal Aid of any changes to my address or
telephone number(s). I will make myself available for interviews, meetings, and court hearings.
I will provide Legal Aid staff with any requested information or documentation such as income
verification or documents to be filed with the court. In the event I do not provide said
information in a timely manner, Legal Aid will mail me a “15 day letter” requesting the
information. Thereafter, if I do not comply within the 15 day period, Legal Aid may close my
case and file a Withdrawal of Counsel with the court. Once a case has been closed, any request
to re-open the case will require a new application and client fee based on the household income
at the time of the reapplication.
4.
I understand and agree that the flat fee charged for representation of my case is
non-refundable after Legal Aid has completed the following: received my request for services;
conducted a conflict check; pre-screened for eligibility; provided me with an application form
packet; created a case file; entered case into Legal Aid’s data base; reviewed my application
form (attorney); and had a paralegal conduct an intake interview and prepare legal documents
necessary to file my case. Any refund requested of the flat fee for service made prior to the
completion of the services set forth above shall be reduced for the services rendered at the rate of
$100 per hour.
5.
I understand that Legal Aid will provide this service through staff attorneys and
paralegals and that there may be changes in the staff designated to assist me with my case.
6.
I assign to Legal Aid any rights to retain and collect any attorney’s fees and/or
court costs that may be awarded to me in this matter.
7.
I understand and agree that Legal Aid does not pursue collection of judgments
including orders, commonly known as Qualified Domestic Relations Orders (QDROS), relating
to the disbursement of any pension and profit sharing plans in a divorce decree. I also
understand that if I am awarded interest in any pension or profit sharing plan in the divorce
decree that it might be necessary to submit such QDROS to the plan administrator within twelve
months of any final order in this matter in order to protect any interest awarded to me in such a
plan. In acknowledging the above, I hereby release Legal Aid from any responsibility
whatsoever to pursue the submittal and approval of a QDRO on my behalf.
8.
I understand that because of Legal Aid’s limited resources, Legal Aid can only
accept and prosecute cases involving simple property issues such as a marital home, simple
financial accounts (checking, savings bank accounts), pension and retirement accounts, and
personal property (household furnishings, vehicles, personal effects, etc.). I also understand that
Legal Aid is unable to accept and prosecute cases involving complex property issues such as real
property (other than a marital home), business entities, trusts, family inheritance, intricate
financial accounts, etc.
9.
I understand that upon completion and/or the closing of my case, that Legal Aid
will file a Withdrawal of Counsel with the court which terminates their representation in my
case. Thereafter, Legal Aid will store my case file for a period of two (2) years and then my file
will be destroyed. I understand that I may obtain my file by submitting a written request to
Legal Aid within two years from the date my case is closed.
10.
During the prosecution of my case, Legal Aid will provide me copies of all
correspondence, documents and pleadings filed in my case and I understand that it is my
responsibility to keep said copies. Therefore, I agree to pay Legal Aid for any charges incurred
by them for additional copies or charges incurred to copy my entire file.
11.
Legal Aid does not provide signed or certified copies of court orders. I
understand that I can obtain signed copies and/or certified copies of all papers filed with the
Court in my legal proceedings at any time from the Third Judicial District Court, Salt Lake
County Clerk’s office and that I have been informed that there will be a small cost for those
copies.
DATED this _____ day of _______________, 2013.
______________________________________
~[Client]
~[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: 328-8849
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, SALT LAKE DEPARTMENT, STATE OF UTAH
______________________________________________________________________________
)
~[PETITIONER],
)
Petitioner,
NOTICE TO THE DEPARTMENT
)
OF HUMAN SERVICES
vs.
)
~[RESPONDENT],
)
Civil No. _____________________
Respondent.
)
Judge ________________________
)
Commissioner __________________
______________________________________________________________________________
TO THE STATE OF UTAH, by and through the Department of Social Services:
Notice is hereby given that ~[Client], Petitioner, has commenced an action against
~[Opposing Party], Respondent, Social Security Number, ~[last four digits of Respondent's
SS# / unknown] in the Third District Court in and for Salt Lake County, State of Utah, for
divorce. There are ~[number] minor children and the Petitioner is asking for $~[amount-cs] per
month as child support, pursuant to the Uniform Child Support Guidelines.
DATED this _____ day of _______________________________, 2013.
LEGAL AID SOCIETY OF SALT LAKE
___________________________________
~[Attorney]
Attorney for Petitioner
CERTIFICATE OF DELIVERY
On this ____ day of _______________________, 2013, I deposited in the Assistant
Attorney General's box in the Clerk's Office of the Third Judicial District Court a true and
correct copy of the foregoing Notice to Department of Human Services.
___________________________________
~[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: 328-8849
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, SALT LAKE DEPARTMENT, STATE OF UTAH
_________________________________________________________________________
)
~[PETITIONER],
)
ACCEPTANCE OF SERVICE,
PETITIONER,
APPEARANCE, WAIVER AND
)
CONSENT TO DEFAULT
vs.
)
Civil No. ________________________
~[RESPONDENT],
)
Judge ___________________________
Respondent.
)
Commissioner _____________________
_________________________________________________________________________
COMES NOW RESPONDENT, ~[RESPONDENT], having received a copy of the
Summons, Complaint for Divorce, Notice of Mandatory Educational Course for Divorcing
Parents, Notice of Mandatory Divorce Orientation Course, and Notice of Mandatory Divorce
Mediation Program in the above-entitled matter, having read the allegations contained therein
and being aware of Respondent's right to seek legal advice, herewith enters Respondent's
appearance consenting to personal jurisdiction of this Court, waives the statutory time in which
to Answer or otherwise respond to Petitioner's Complaint, and consents that judgment by default
may be entered against Respondent at any time and without further notice to Respondent.
DATED this _____ day of ______________________, 2013.
___________________________________
~[Opposing Party]
Respondent
___________________________________
Address
___________________________________
City
State
Zip Code
STATE OF
____________
County of
____________
)
: ss.
)
On this _____ day of _____________________, 2013, personally appeared before me
~[Opposing Party], who duly acknowledged to me that he executed the foregoing instrument.
___________________________________
NOTARY PUBLIC
Residing in:
[date]
~[Opposing Party]
~[Address]
~[City, etc.]
RE: ~[Doe v. Doe]
Dear Mr. ~[Opposing Party],
Your spouse feels there is no further chance of reconciling your marriage and has
initiated a divorce proceeding against you through this office. Enclosed please find an original
Acceptance of Service, Appearance, Consent and Waiver along with copies of all relevant
pleadings for your records.
If you agree with the terms of the Complaint, please sign the Acceptance of Service,
Appearance, Consent and Waiver, before a notary public and return it to this office within fifteen
(15) days. If you sign and return the Acceptance within the fifteen (15) days, our office will
waive the Attorney’s fees in this matter. Such action on your part will notify the Court that you
do not wish to contest the proceedings in this matter and that a Decree of Divorce will be entered
with no further notice provided to you. However, a Decree of Divorce will be mailed to you at
the conclusions of this matter incorporating the terms of the original Complaint.
If you have any questions or do not agree with the terms or you desire to contest the
divorce, I urge you to consult an attorney of your choice.
Very truly yours,
LEGAL AID SOCIETY OF SALT LAKE
~[Attorney]
Attorney for Petitioner
CLIENT DISCLOSURE AND AUTHORIZATION
FOR STUDENT REPRESENTATION
I have been informed that the Legal Aid Society of Salt Lake utilizes Third-Year Law Students
from the University of Utah to work as legal interns under the supervision of an attorney and in
compliance with course requirements of the University of Utah College of Law. I hereby authorize said
students to represent me and do all things necessary to represent me.
I also agree that said students or their supervising attorney may provide and release any
information in my case to the students’ supervisor at the University of Utah College of Law.
_______________________________________
Date
_______________________________________
Client
IN THE THIRD DISTRICT COURT
SALT LAKE COUNTY, STATE OF UTAH
EXHIBIT ___
:
~[PETITIONER],
Petitioner,
vs.
~[RESPONDENT],
Respondent.
:
CHILD SUPPORT OBLIGATION WORKSHEET
:
:
:
:
:
:
(SOLE CUSTODY AND PATERNITY)
Civil No.
Judge
Mother
Father
$
$
$
$
1.
Enter the # of natural and adopted children of this mother and father for whom
support is to be awarded.
2a.
Enter the father’s and mother’s gross monthly income. Refer to instructions for
definition of income.
2b.
Enter previously ordered alimony that is actually paid. (Do not enter alimony
ordered for this case.)
2c.
Enter previously ordered child support. (Do not enter obligations ordered for the
children in Line l.)
2d.
OPTIONAL: Enter the amount from Line 12 of the Children in Present Home
Worksheet for either parent.
3.
Subtract Lines 2b, 2c, and 2d from 2a. This is the Adjusted Gross Income for child
support purposes.
4.
Take the COMBINED figure in Line 3 and number of children in Line 1 to the
support Table. Find the Base Combined Support Obligation. Enter it here.
5.
Divide each parent’s adjusted monthly gross in Line 3 by the COMBINED
adjusted monthly gross in Line 3.
%
%
6.
Multiply Line 4 by Line 5 for each parent to obtain each parent’s share of the Base
Support Obligation.
$
$
7.
8.
9.
Combined
$
$
BASE CHILD SUPPORT AWARD: Bring down the amount(s) from the Low
Income Table per U.C.A. 78-45-7.7. The parent(s) without physical custody of the
child(ren) pay(s) the amount(s) all 12 months of the year.
$
Which parent is the obligor? _______ Mother __________ Father ________ Both
Is the support award the same as the guideline amount(s) in Line 7? ( ) Yes ( ) No
If No, enter the amount(s) ordered: $_________(Father)
$__________________(Mother) , and answer number 10.
10.
What were the reasons stated by the Court for the Deviation?
( ) Property settlement
( ) Excessive debts of marriage
( ) Absence of need of the custodial parent
6/2000
Attorney Bar No.
( ) Electronic Filing
(X) Manual Filing
~[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: 328-8849
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, SALT LAKE DEPARTMENT, STATE OF UTAH
________________________________________________________________________
)
~[PETITIONER],
)
MOTION AND AFFIDAVIT FOR
Petitioner,
WAIVER OF COURT FEES:
)
Clients of Legal Agencies and
vs.
Special Assistance Programs
)
~[RESPONDENT],
)
Civil No.
Respondent.
)
Judge
)
Commissioner
________________________________________________________________________
(1)
I move to waive the following court fees: (Choose  all that apply.)
Filing Fee
OCAP Fee
Divorce Education Fee
Parenting Class
Service Fee
Future fees for writs
Other (Describe)
Other (Describe)
I swear or affirm that:
(2)
Due to my poverty, I am unable to bear the expenses of these legal proceedings,
and I believe that I am entitled to the relief sought.
(3)
This is a domestic case involving a final or temporary order for alimony,
child support, debt division, property division, attorney fees paid by the other party, or
modification of those orders in which I have to file a Financial Declaration. I have attached the
Financial Declaration required for such cases.
(4)
I receive public assistance under: (check all that apply and attach the financial
statement used to qualify for the program)
 Temporary Assistance to Needy Families (TANF); or
 Supplemental Security Income (SSI); or
 Medicaid; or
 General Assistance (GA); or
 Other _________________________________________ (describe);
and
The attached financial information is true and correct.
(5)
I am being represented in this action by: (check all that apply and attach the
financial statement used to qualify for representation)
 Utah Legal Services, or an attorney designated by Utah Legal Services; or
The Legal Aid Society of Salt Lake;
and
 The attached financial information is true and correct.
(6)
I have attached a Financial Affidavit Supporting Motion to Waive Fees.
I have not included any non-public information in this document.
D
Sign here ►
Date:
Typed or printed name
I certify that __________________________, who is known to me or who presented
satisfactory identification, has, while in my presence and while under oath or affirmation,
voluntarily signed this document and declared that it is true.
D
Sign here ►
Date:
Typed or printed name (Notary Public)
Notary Seal
~[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: 328-8849
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, SALT LAKE DEPARTMENT, STATE OF UTAH
________________________________________________________________________
)
~[PETITIONER],
)
Petitioner,
COURT ORDER ON MOTION
)
FOR WAIVER OF COURT FEES
vs.
)
~[RESPONDENT],
Civil No.
)
Respondent.
Judge
)
Commissioner
________________________________________________________________________
Having reviewed the Motion and Affidavit to Waive Fees and supporting financial evidence, and
having made an independent determination based on the information,
The Court Orders that:
(1)
The motion is denied. The party must pay all fees associated with this case.
(2)
The motion is granted. The following fees are waived in full or in part.
Fee
Filing Fee
OCAP Fee
Divorce Education Fee
Parenting Class
Service Fee
Future fees for writs
Other (Describe)
Other (Describe)
(3)
Waived
in Full
Amount of Fee
$
$
$
$
$
$
$
$
Amount to be
Paid by Party
$
$
$
$
$
$
$
$
This order is subject to review and amendment until the final judgment or decree.
Date
Sign here ►
Recommended by Commissioner
Date
District Court Judge
Sign here ►
~[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: 328-8849
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, SALT LAKE DEPARTMENT, STATE OF UTAH
______________________________________________________________________________
)
~[PETITIONER],
)
Petitioner,
MOTION FOR TEMPORARY RELIEF
)
vs.
)
~[RESPONDENT],
)
Civil No. ~[civil no.]
Respondent.
)
Judge ~[Judge]
)
Commissioner ~[Commissioner]
______________________________________________________________________________
COMES NOW the above-named Petitioner, by and through attorney, ~[Attorney],
LEGAL AID SOCIETY OF SALT LAKE, and respectfully moves this Court for the following
temporary orders:
INSERT RELEVANT PROVISIONS FROM COMPLAINT, ADD “TEMPORARY” TO
APPROPRIATE PROVISIONS, I.E. TEMPORARY CUSTODY, SUPPORT, DEBT
PAYMENT, ETC.
*.
Respondent should be ordered to pay Petitioner's attorney's fees and Petitioner be
awarded judgment against Respondent for attorney’s fees in the sum of $150.00 for having to
bring this matter before the court.
*.
Petitioner has received public assistance from the State, and has assigned the right
to collect child support accrued during the time public assistance was received to the State of
Utah. Therefore, pursuant to Utah Code Ann. 78B-12-113, the State of Utah should be joined as
a party in interest in the above-entitled cause of action.
*.
The Court should order such other and further temporary relief as may be
determined by the Court to be just and proper.
DATED this _____ day of __________________________, 2013.
LEGAL AID SOCIETY OF SALT LAKE
___________________________________
~[Attorney]
Attorney for Petitioner
Pursuant to Rule 4-202.09 of the Utah Rules of Judicial Administration, the above-signed
declares that non-public information has been omitted and/or redacted from this document.
CERTIFICATE OF MAILING
On this _________ day of ______________________, 2013, I deposited in the United
States Mail,postage prepaid, a true and correct copy of the foregoing Motion for Temporary
Relief to:
~[Opposing Party/Attorney]
~[Client/address]
________________________________
CERTIFICATE OF DELIVERY
On this
day of _____________________, 2013, I deposited in the United States
Mail, postage prepaid, a true and correct copy of the foregoing Motion for Temporary Relief to:
~[Opposing Party/Attorney]
~[Client/address]
and placed a true and correct copy in the Attorney General's box in the Clerk's Office of the
Third Judicial District Court.
________________________________
[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: 328-8849
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, SALT LAKE DEPARTMENT, STATE OF UTAH
______________________________________________________________________________
)
~[PETITIONER],
)
Petitioner,
NOTICE OF HEARING
)
vs.
)
~[RESPONDENT],
)
Civil No. ~[civil no.]
Respondent.
)
Judge ~[Judge]
)
Commissioner ~[Commissioner]
______________________________________________________________________________
TO THE ABOVE-NAMED RESPONDENT:
Please take notice that a hearing on Petitioner's Motion for Temporary Relief has been
scheduled for ~[day, date, time], 2005, before:
Commissioner Michael S. Evans in Room W38 of the above entitled Court at the Scott
M. Matheson Courthouse, 450 South State Street, Salt Lake City, Utah,
Commissioner T. Patrick Casey in Room W36 of the above entitled Court at the Scott M.
Matheson Courthouse, 450 South State Street, Salt Lake City, Utah,
Commissioner Thomas N. Arnett, Jr. in Room W32 of the above entitled Court at the
Scott M. Matheson Courthouse, 450 South State Street, Salt Lake City, Utah,
Commissioner Michelle R. Blomquist in Room W34 of the above entitled Court at the
Scott M. Matheson Courthouse, 450 South State Street, Salt Lake City, Utah,
PLEASE GOVERN YOURSELVES ACCORDINGLY.
DATED this _____ day of __________________________, 2013.
LEGAL AID SOCIETY OF SALT LAKE
___________________________________
~[Attorney]
Attorney for Petitioner
CERTIFICATE OF MAILING
On this _____ day of ________________________, 2013, I deposited in the United
States Mail, postage prepaid, a true and correct copy of the foregoing Notice of Hearing to:
~[Opposing Party/Attorney]
~[Client]
________________________________________
CERTIFICATE OF DELIVERY
On this _____ day of ________________________, 2013, I mailed a true and correct
copy of the foregoing Notice of Hearing, postage prepaid, to:
~[Opposing Party/Attorney]
~[Client]
and placed a true and correct copy of the same in the Assistant Attorney General's box in the
Clerk's Office of the Third Judicial District Court.
___________________________________
~[ATTORNEY, BAR NO.]
LEGAL AID SOCIETY OF SALT LAKE
ATTORNEY FOR PETITIONER
205 NORTH 400 WEST
SALT LAKE CITY, UTAH 84103
TELEPHONE: (801) 328-8849
FACSIMILE: (801) 359-7359
IN THE THIRD JUDICIAL DISTRICT COURT
OF SALT LAKE COUNTY, STATE OF UTAH
______________________________________________________________________________
)
~[PETITIONER],
)
AFFIDAVIT OF PETITIONER
Petitioner,
IN SUPPORT OF MOTION FOR
)
TEMPORARY RELIEF
vs.
)
~[RESPONDENT],
)
Civil No. ~[civil no.]
Respondent.
)
Judge ~[Judge]
)
Commissioner ~[Commissioner]
______________________________________________________________________________
STATE OF UTAH
)
:ss
County of Salt Lake
)
~[Client] (Affiant) being first duly sworn and under oath deposes and states as follows:
1.
I am the Petitioner in the above-entitled matter.
2.
NOTE: When custody is contested, refer to custody criteria in I-manage to include in
affidavit.
DATED this _____ day of ___________________________, 2013.
___________________________________
~[Client]
AFFIANT
SUBSCRIBED AND SWORN TO before me this _____ day of ______________, 2013.
___________________________________
NOTARY PUBLIC
Residing in:
CERTIFICATE OF MAILING
On this _________ day of ____________________, 2013, I deposited in the United
States Mail, postage prepaid, a true and correct copy of the foregoing Affidavit to:
~[Opposing Party/Attorney]
~[Client/address]
________________________________
CERTIFICATE OF DELIVERY
On this
day of ___________________, 2013, I deposited in the United States Mail,
postage prepaid, a true and correct copy of the foregoing Affidavit to:
~[Opposing Party/Attorney]
~[Client/address]
and placed a true and correct copy in the Attorney General's box in the Clerk's Office of the
Third Judicial District Court.
_________________________________________
Non-public Information – Parent
Case Number ___________________________
Identification and Location
Notice: This information is required by the U.S. Secretary of Health and Human Services. If the
information changes, you must complete and file another form. (Utah Code Section 62A-11-304.4.)
Name
Telephone Numbers (Include area code.)
Day
Evening
Cell
Residential Address
Keep my residential address private and do not provide it to the other party because there is reason
to believe that releasing the information may result in physical or emotional harm to me or to my child.
(If you check this box, omit your residential address from this document and from all other papers filed with the court.
Include it on the Safeguarded Address form.)
Mailing Address (if different from residential address)
Date of Birth
Social Security Number
Driver's License
State
Number
Employer Name, Address and Telephone Number
Employer Name, Address and Telephone Number
I am: (check all that apply)
Petitioner
Respondent
Custodial Parent
Filing this information about myself
Non-custodial Parent
Filing this information about the other party
I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true and correct.
Date
Sign here ►
Typed or printed name
Judicial Services Representative: This is a private record.
Non-public Information – Minors
Case Number ______________________
Use this document to provide non-public information to the court. Write the information here, and omit it from the
public document. Complete as many forms as needed. Serve this form on the other party.
I swear or affirm that the following information is true.
* Keep the residential address private and do not provide it to the other party because there is reason to believe
that releasing the information may result in physical or emotional harm to me or to my child. (If you check this box,
omit the child’s residential address from this document and from all other papers filed with the court. Include it on
the Safeguarded Address form.)
(1) Name of Minor
Residential Address*
Date of Birth
Sex
Social Security Number
(A) Places where this minor has lived during the last 5 years. Person the minor lived with. Address of that person.
(Required only if custody or parent time is part of the case. Section 78B-13-209.)
(B) Name and address of anyone (other than Petitioner or Respondent) who has or who claims a right to custody or
parent-time. (Required only if custody or parent time is part of the case. Section 78B-13-209.)
(2) Name of Minor
Residential Address*
Date of Birth
Sex
Social Security Number
(A) Places where this minor has lived during the last 5 years. Person the minor lived with. Address of that person.
(Required only if custody or parent time is part of the case. Section 78B-13-209.)
(B) Name and address of anyone (other than Petitioner or Respondent) who has or who claims a right to custody or
parent-time. (Required only if custody or parent time is part of the case. Section 78B-13-209.)
(3) Name of Minor
Residential Address*
Date of Birth
Sex
Social Security Number
(A) Places where this minor has lived during the last 5 years. Person the minor lived with. Address of that person.
(Required only if custody or parent time is part of the case. Section 78B-13-209.)
(B) Name and address of anyone (other than Petitioner or Respondent) who has or who claims a right to custody or
parent-time. (Required only if custody or parent time is part of the case. Section 78B-13-209.)
(4) Name of Minor
Residential Address*
Date of Birth
Sex
Social Security Number
(A) Places where this minor has lived during the last 5 years. Person the minor lived with. Address of that person.
(Required only if custody or parent time is part of the case. Section 78B-13-209.)
(B) Name and address of anyone (other than Petitioner or Respondent) who has or who claims a right to custody or
parent-time. (Required only if custody or parent time is part of the case. Section 78B-13-209.)
(5) Name of Minor
Residential Address*
Date of Birth
Sex
Social Security Number
(A) Places where this minor has lived during the last 5 years. Person the minor lived with. Address of that person.
(Required only if custody or parent time is part of the case. Section 78B-13-209.)
(B) Name and address of anyone (other than Petitioner or Respondent) who has or who claims a right to custody or
parent-time. (Required only if custody or parent time is part of the case. Section 78B-13-209.)
Date
Sign here ►
Typed or printed name
I certify that __________________________, who is known to me or who presented satisfactory identification, has,
while in my presence and while under oath or affirmation, voluntarily signed this document and declared that it is
true.
Date:
Sign here ►
Typed or printed name (Court Clerk or Notary Public)
Notary Seal
Judicial Services Representative: This is a private record.
Certificate of Service
I certify that I served a copy of this Non-public Information Form on the following people.
Person’s Name
(Other Party or Attorney)
(Clerk of Court)
Date
Typed or printed name
Method of Service
Mail
Hand Delivery
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.)
Mail
Hand Delivery
Electronic File
Mail
Hand Delivery
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.)
Mail
Hand Delivery
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 ►
Served at this Address
Served on
this Date
Non-public Information – Personal
Information
Case Number _____________________
Use this document to provide non-public information to the court. Write the information here, and omit it from the
public document. Complete as many forms as needed. Serve this form on the other party.
Non-public information about a party
Plaintiff/Petitioner
Information
Defendant/Respondent
Name (Public)
Social Security Number
Driver License State / Number
Account Names and Numbers
Non-public information about a non-party (Business information should be provided on public documents.
Complete this section only if personal information is the only means to contact this person.)
Name (Public)
Residential
Address
Personal
Phone
Personal E-mail
This Person is












Plantiff/Petitioner’s Employer
Defendant/Respondent’s Employer
Holder of Property
Other Non-party
Plantiff/Petitioner’s Employer
Defendant/Respondent’s Employer
Holder of Property
Other Non-party
Plantiff/Petitioner’s Employer
Defendant/Respondent’s Employer
Holder of Property
Other Non-party
Other non-public information
Public Document Title
Paragraph
Number
Non-public Information
I declare that under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true and
correct.
Date
Sign here ►
Typed or printed name
Judicial Services Representative: This is a private record.
Certificate of Service
I certify that I served a copy of this Non-public Information Form on the following people.
Person’s Name
Method of Service
Mail
Hand Delivery
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
(Other Party or Attorney)
(Clerk of Court)
discretion residing there.)
Mail
Hand Delivery
Electronic File
Mail
Hand Delivery
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.)
Mail
Hand Delivery
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.)
Date
Sign here ►
Typed or printed name
Served at this Address
Served on
this Date
Non-public Information – Safeguarded
Address
Case Number ______________________
Instructions: A party’s residential address (or that of a party’s child) can be safeguarded from the other party in the 5
types of cases listed below. Safeguarding an address is your choice. If your case is one of these casetypes and if you
want to safeguard your residential address (or that of your child) from the other party, write the address here, and
omit it from the public document. Omit it also from the Non-public Information about Minors form and from the
Parent Identification and Location form. File this form with the judicial service assistant, but do not serve this form
on the other party.
Name*
Residential Address
City, State, Zip**
*Name of an adult may be included on public records.
**City, state and zip code may be included on public records.
Keep this residential address private and do not provide it to the other party because this
proceeding is about:
 a protective order (Utah Code Section 78B-7-109)
 a stalking injunction (Utah Code Section 77-3a-101)
 a parentage order (Utah Code Section 62A-11-304.4)
 a custody order (Utah Code Section 78B-13-209)
 a support order (Utah Code Section 78B-14-312)
I declare that under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true and
correct.
Date
Sign here ►
Typed or printed name
Judicial Services Representative: This is a private record.