Checklist for Filing a Counterclaim

x You must complete a form before you file it. These instructions will
help you complete the forms.
x The judicial services representative cannot complete a form for you.
x Attach a copy of any document referred to in the form.
x Keep a copy of all documents for your records.
x Attend all court hearings.
x Some forms may not apply in your case.
x Check with your court about local requirements.

(1) Do I have a counterclaim?

x The Complaint/Petition tells you what the plaintiff/petitioner wants the court to do.
Read the Complaint/Petition carefully. You must file an answer to the
Complaint/Petition of the court might enter a default judgment against you. To help
you complete an answer, see the checklist accompanying that form.
x A counterclaim is the defendant’s opportunity to sue the plaintiff. You may not have
any counterclaims, but only a lawyer can advise you. For more information about
counterclaims, see URCP 13.
x If your claim against the plaintiff arises out of the same transaction or occurrence as
the plaintiff’s claim against you, the counterclaim is mandatory. If you have a
mandatory counterclaim against the plaintiff, it means that you must file the claim or
you may lose it.
x If your claim against the plaintiff arises out of a different transaction or occurrence as
the plaintiff’s claim against you, the counterclaim is permissive. If you have a
permissive counterclaim against the plaintiff, it means that you can file the claim as a
counterclaim but you do not have to.

(2) To complete your counterclaim

… Print your name and contact information in the upper left hand corner of the form.
Check whether you are the defendant/respondent or the attorney for the
defendant/respondent.
… Complete the heading exactly as it appears in the Complaint/Petition.
… State whether your claim is a tier 1, tier 2 or tier 3 case. The tier determines how
much discovery is allowed and the time in which to complete discovery. For more
information, see our webpage on Disclosure and Discovery. If you are not asking
for damages, your counterclaim is a tier 2 case. If you are asking for damages,
the amount of damages determines the tier:
o Tier 1: $50,000 or less

2012.03
 o Tier 2: More than $50,000 and less than $300,000
o Tier 3: $300,000 or more
… Omit any private and protected information. When filed, this document becomes
a public record. Code of Judicial Administration Rule 4-202.09(9) requires that
you omit from a public record any information that is not itself public information.
For a list of records and data that are classified as public, private, and protected,
see Rule 4-202.02. You may file non-public information with the court on a non-
public information form. For more information, forms and instructions see our
webpage on Non-public Records.
… On the blank lines, print a short and plain statement of the claim showing that
you are entitled to relief. Each paragraph should be on a separately numbered
set of lines.

(3) To add a request

… If you make a counterclaim against the plaintiff, you must also tell the court what
you want it to do. For example, you could ask the court to award you damages.
… On the blank lines, print a short and plain statement of what you want the court to
do. Each paragraph should be on a separately numbered set of lines.

(4) Date, sign and file your Counterclaim.

… Complete the Certificate of Service.
… Serve the form on the other party.
… File the form with the judicial services representative.
… There is no fee for filing an Answer, but there is a fee for a counterclaim. For
more information, see our webpage on Fees.

2012.03
 [ ] This is a private record
Name

Address

City, State, Zip

Phone

Email

I am the [ ] Plaintiff/Petitioner
[ ] Defendant/Respondent
[ ] Attorney for the [ ] Plaintiff/Petitioner [ ] Defendant/Respondent and my
Utah Bar number is _________

In the [ ] District [ ] Juvenile [ ] Justice Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

Counter Motion to
_______________________________
_____________________________________ [ ] Hearing Requested
Plaintiff/Petitioner
_______________________________
v. Case Number

_____________________________________ _______________________________
Defendant/Respondent Judge
_______________________________
Commissioner

(1) I ask the court to enter an order as follows:

(State what you want the court to order)

Counter Motion Approved Board of District Court Judges December 18, 2015 Page 1 of 3
(2) I ask for this order because:
(State why you want the court order.)

(3) [ ] The motion is supported by the law because:

(Cite any statutes, ordinances, rules or appellate opinions that support/oppose the motion. For
example, Utah Code section 15-1-201, or Utah Rules of Civil Procedure 67. Explain why they
support the motion.)

(4) [ ] I request a hearing.

[ ] I do not request a hearing.

(5) [ ] I have attached the following documents in support of this motion:

(6) [ ] The other party agrees with this motion, and I have attached the stipulation.

I have not included any non-public information in this document.

I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true.

Sign here ►
Date
Typed or Printed Name

Counter Motion Approved Board of District Court Judges December 18, 2015 Page 2 of 3
 Certificate of Service
I certify that I served a copy of this document on the following people.
Served at this Served on
Person’s Name Method of Service Address this Date
[ ] 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
(Other Party or Attorney) and discretion residing there.)
[ ] Mail
[ ] Hand Delivery
(Clerk of Court) [ ] 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 ►
Date
Typed or Printed Name

Counter Motion Approved Board of District Court Judges December 18, 2015 Page 3 of 3
 [ ] This is a private record.
Name

Address

City, State, Zip

Phone

Email

I am the [ ] Plaintiff/Petitioner
[ ] Defendant/Respondent
[ ] Attorney for the [ ] Plaintiff/Petitioner [ ] Defendant/Respondent and my
Utah Bar number is _________

In the [ ] District [ ] Justice Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

Motion to Set Aside Judgment

Pursuant to URCP 60(b)
_____________________________________
Plaintiff/Petitioner [ ] Hearing Requested
_______________________________
v. Case Number

_____________________________________ _______________________________
Defendant/Respondent Judge
_______________________________
Commissioner

[ ] Plaintiff/Petitioner [ ] Defendant/Respondent moves the court to set aside the

judgment entered against him/her on _________________________________ (date).

(1) This motion is brought pursuant to the subsection(s) of Utah Rule of Civil
Procedure 60(b) indicated below, and for the reason(s) described (choose as many
as apply):

Motion to Set Aside Judgment Approved Board of District Court Judges June 19, 2015 Page 1 of 4
Revised December 21, 2015
 (State the facts of your case that support the motion. Make your statements in clear, simple
sentences. The person signing this document must have first-hand knowledge of the facts
stated.)

[ ] Rule 60(b)(1) - mistake, inadvertence, surprise, or excusable neglect

(describe):

[ ] Rule 60(b)(2) newly discovered evidence which could not have been
discovered in time to move for a new trial under Rule 59(b) (describe):

[ ] Rule 60(b)(3) fraud, misrepresentation or other misconduct of the other

party (describe):

[ ] Rule 60(b)(4) the judgment is void (describe):

[ ] Rule 60(b)(5) the judgment has been satisfied, released, or discharged, or

a prior judgment upon which it is based has been reversed or otherwise vacated,
or it is no longer equitable that the judgment should have prospective application
(describe):

Motion to Set Aside Judgment Approved Board of District Court Judges June 19, 2015 Page 2 of 4
Revised December 21, 2015
 [ ] Rule 60(b)(6) any other reason justifying relief from the operation of the
judgment.

(2) Choose all that apply:

[ ] I have relied on reason (1), (2) or (3), and am making this motion within 90
days of the judgment.

[ ] I have relied on reason (4), (5) or (6), and am making this request in a
reasonable time because (explain):

(3) The reasons that I disagree with the original complaint/petition, and the facts
supporting my disagreement, are as follows:

(4) [ ] I request a hearing.

[ ] I do not request a hearing.

I have not included any non-public information in this document.

I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true.

Sign here ►
Date
Typed or Printed Name

Motion to Set Aside Judgment Approved Board of District Court Judges June 19, 2015 Page 3 of 4
Revised December 21, 2015
 Certificate of Service
I certify that I served a copy of this document on the following people.

Served at this Served on

Person’s Name Method of Service Address this Date
[ ] Mail
[ ] Hand Delivery
[ ] E-filed
[ ] Fax (Person agreed to service by fax.)
[ ] Email (Person agreed to service by email.)
[ ] Left at business (With person in charge
or in receptacle for deliveries.)
[ ] Left at home (With person of suitable
(Other Party or Attorney) age and discretion residing there.)
[ ] Mail
[ ] Hand Delivery
(Clerk of Court) [ ] E-filed
[ ] Mail
[ ] Hand Delivery
[ ] E-filed
[ ] Fax (Person agreed to service by fax.)
[ ] Email (Person agreed to service by email.)
[ ] Left at business (With person in charge
or in receptacle for deliveries.)
[ ] Left at home (With person of suitable
age and discretion residing there.)
[ ] Mail
[ ] Hand Delivery
[ ] E-filed
[ ] Fax (Person agreed to service by fax.)
[ ] Email (Person agreed to service by email.)
[ ] Left at business (With person in charge
or in receptacle for deliveries.)
[ ] Left at home (With person of suitable
age and discretion residing there.)

Sign here ►
Date
Typed or Printed Name

Motion to Set Aside Judgment Approved Board of District Court Judges June 19, 2015 Page 4 of 4
Revised December 21, 2015
My Name

Address

City, State, Zip

Phone

Email

I am the [ ] Plaintiff/Petitioner
[ ] Defendant/Respondent
[ ] Attorney for: [ ] Plaintiff/Petitioner [ ] Defendant/Respondent, and my
Utah Bar number is _________

In the [ ] District [ ] Juvenile [ ] Justice Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

Stipulation to the Motion to

_____________________________________ ______________________________
Plaintiff/Petitioner
_______________________________
v. Case Number
_______________________________
_____________________________________ Judge
Defendant/Respondent
_______________________________
Commissioner

Instructions:
x You must complete this form before you file it. Court staff cannot complete this form for you.
x Keep a copy of all documents for your records.
x Attend all court hearings.

[ ] By and through my attorney, (Attorney, check here if you are appearing for your client.)

I say as follows:

Stipulation to the Motion Approved Board of District Court Judges September 22, 2010 Page 1 of 3
Revised April 15, 2015
(1) [ ] I have received and read the Motion to ___________________________
and its supporting documents. I fully understand the claims and the requested
order.

(2) [ ] I understand that I have the right to contest the claims and to have a judge
decide the issues.

(3) [ ] I voluntarily stipulate that the court may grant the order requested in the
motion at any time and without further notice.
I have not included any non-public information in this document.
I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true.

Sign here Ź
Date
Typed or Printed Name

Stipulation to the Motion Approved Board of District Court Judges September 22, 2010 Page 2 of 3
Revised April 15, 2015
 Certificate of Service
I certify that I served a copy of this document on the following people.
Served at this Served on
Person’s Name Method of Service Address this Date
[ ] 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
(Other Party or Attorney) and discretion residing there.)
[ ] Mail
[ ] Hand Delivery
(Clerk of Court) [ ] 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 Ź
Date
Typed or Printed Name

Stipulation to the Motion Approved Board of District Court Judges September 22, 2010 Page 3 of 3
Revised April 15, 2015
My Name

Address

City, State, Zip

Phone

Email

In the [ ] District [ ] Justice Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

Order on Motion to Set Aside

Judgment
_____________________________________
Plaintiff/Petitioner _______________________________
Case Number
v.
_______________________________
_____________________________________ Judge
Defendant/Respondent _______________________________
Commissioner

The matter before the court is a Motion to Set Aside Judgment. This matter is being
resolved by: (Choose all that apply.)

[ ] The default of [ ] Plaintiff/Petitioner [ ] Defendant/Respondent.

[ ] The stipulation of the parties.

[ ] The pleadings and other papers of the parties.

[ ] A hearing held on __________________________ (date), notice of which was

served on all parties.

Plaintiff/Petitioner

[ ] was present.

Order on Motion to Set Aside Judgment Approved Board of District Court Judges June 19, 2015 Page 1 of 5
 [ ] was not present.

[ ] was represented by _______________________ (name).

[ ] was not represented.

Defendant/Respondent

[ ] was present.

[ ] was not present.

[ ] was represented by _______________________ (name).

[ ] was not represented.

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

The Court Finds That:

(1) The moving party

[ ] has not shown good cause to set aside the judgment

[ ] has shown good cause to set aside the judgment pursuant to the subsection(s)
of URCP 60(b) selected below:

[ ] (1) - mistake, inadvertence, surprise, or excusable neglect

[ ] (2) - newly discovered evidence which could not have been discovered
in time to move for a new trial under Rule 59(b)

[ ] (3) - fraud, misrepresentation or other misconduct of the other party

[ ] (4) - the judgment is void

[ ] (5) - the judgment has been satisfied, released, or discharged, or a

prior judgment upon which it is based has been reversed or
otherwise vacated, or it is no longer equitable that the judgment
should have prospective application

[ ] (6) - any other reason justifying relief from the operation of the
judgment

[ ] for the reasons set forth in the motion, or

Order on Motion to Set Aside Judgment Approved Board of District Court Judges June 19, 2015 Page 2 of 5
 [ ] because:

(2) The motion [ ] was [ ] was not made in a reasonable time.

(3) The moving party [ ] has [ ] has not set forth a meritorious defense to the
underlying complaint/petition.

The Court Orders That:

(4) The Motion is [ ] granted [ ] denied.

(5) [ ] Defendant/Respondent must file

[ ] an Answer

[ ] other pleading ______________________________________ (specify)

on or before ______________ (date).

(6) [ ] Other:

(7) No additional order is necessary.

This is the order of the court. Nothing further is required of the parties.

Sign here Ź

Date Recommended by Commissioner

Sign here Ź

Date Judge

Order on Motion to Set Aside Judgment Approved Board of District Court Judges June 19, 2015 Page 3 of 5
Approved as to form.
Sign here Ź

Date Plaintiff/Petitioner or Attorney

Sign here Ź

Date Defendant/Respondent or Attorney

Order on Motion to Set Aside Judgment Approved Board of District Court Judges June 19, 2015 Page 4 of 5
 Certificate of Service
I certify that I served a copy of this document on the following people.

Served at this Served on

Person’s Name Method of Service Address this Date
[ ] Mail
[ ] Hand Delivery
[ ] E-filed
[ ] Fax (Person agreed to service by fax.)
[ ] Email (Person agreed to service by email.)
[ ] Left at business (With person in charge
or in receptacle for deliveries.)
[ ] Left at home (With person of suitable
(Other Party or Attorney) age and discretion residing there.)
[ ] Mail
[ ] Hand Delivery
(Clerk of Court) [ ] E-filed
[ ] Mail
[ ] Hand Delivery
[ ] E-filed
[ ] Fax (Person agreed to service by fax.)
[ ] Email (Person agreed to service by email.)
[ ] Left at business (With person in charge
or in receptacle for deliveries.)
[ ] Left at home (With person of suitable
age and discretion residing there.)
[ ] Mail
[ ] Hand Delivery
[ ] E-filed
[ ] Fax (Person agreed to service by fax.)
[ ] Email (Person agreed to service by email.)
[ ] Left at business (With person in charge
or in receptacle for deliveries.)
[ ] Left at home (With person of suitable
age and discretion residing there.)

Sign here Ź
Date
Typed or Printed Name

Order on Motion to Set Aside Judgment Approved Board of District Court Judges June 19, 2015 Page 5 of 5
 [ ] This is a private record
My Name

Address

City, State, Zip

Phone

Email

I am the [ ] Plaintiff/Petitioner
[ ] Defendant/Respondent
[ ] Attorney for the [ ] Plaintiff/Petitioner [ ] Defendant/Respondent and my
Utah Bar number is _________

In the [ ] District [ ] Juvenile [ ] Justice Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

Reply to Memorandum Opposing

Motion to ______________________
_____________________________________ _______________________________
Plaintiff/Petitioner Case Number
_______________________________
v. Judge

_____________________________________ _______________________________
Defendant/Respondent Commissioner

(1) (A) I disagree with the following statement that presents a new matter raised
in the opposing party’s Memorandum Opposing Motion to
____________________________.

Reply to Memorandum Opposing Motion Approved Board of District Court Judges December 18, 2015 Page 1 of 3
 (B) I disagree for the following reasons. (State the relevant facts newly claimed by the
opposing party and any laws cited by the opposing party in their Memorandum Opposing the
Motion.)

(2) (A) I disagree with the following statement that presents a new matter raised
in the opposing party’s Memorandum Opposing Motion to
____________________________.

(B) I disagree for the following reasons. (State the relevant facts newly claimed by the
opposing party and any laws cited by the opposing party in their Memorandum Opposing the
Motion.)

I have not included any non-public information in this document.

I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true.

Sign here ►
Date
Typed or Printed Name

Reply to Memorandum Opposing Motion Approved Board of District Court Judges December 18, 2015 Page 2 of 3
 Certificate of Service
I certify that I served a copy of this document on the following people.
Served at this Served on
Person’s Name Method of Service Address this Date
[ ] 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
(Other Party or Attorney) and discretion residing there.)
[ ] Mail
[ ] Hand Delivery
(Clerk of Court) [ ] 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 ►
Date
Typed or Printed Name

Reply to Memorandum Opposing Motion Approved Board of District Court Judges December 18, 2015 Page 3 of 3
My Name

Address

City, State, Zip

Phone

Email

I am the [ ] Plaintiff/Petitioner
[ ] Defendant/Respondent
[ ] Witness for the [ ] Plaintiff/Petitioner [ ] Defendant/Respondent
[ ] Attorney for the [ ] Plaintiff/Petitioner [ ] Defendant/Respondent and my
Utah Bar number is ___________

In the [ ] District [ ] Juvenile [ ] Justice Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

Statement [ ] Supporting
[ ] Opposing

Motion to ______________________
_____________________________________ [ ] Hearing Requested
Plaintiff/Petitioner
_______________________________
v. Case Number

_____________________________________ _______________________________
Judge
Defendant/Respondent
_______________________________
Commissioner

Instructions:
x You must complete this form before you file it. Court staff cannot complete this form for you.
x Keep a copy of all documents for your records.
x Attend all court hearings.
x Attach the following:

Statement Approved Board of District Court Judges September 22, 2010 Page 1 of 3
Revised April 15, 2015
 o Additional pages as needed to complete paragraphs that don’t have enough space. Write the
paragraph number on the additional page.
o Non-Public Information Form, more fully describing non-public information asked for in this
document.
o Documents supporting your statements (if applicable).

(1) I say as follows: (State the facts of your case that support/oppose the motion. Make your
statements in clear, simple sentences. Make each point a separate paragraph. Number the
paragraphs. Arrange the paragraphs logically. Type your statements or print them clearly. The
person signing this document must have first-hand knowledge of the facts stated.)

(2) [ ] I request a hearing.

[ ] I do not request a hearing.

(3) List any documents you have attached that support your statements.

I have not included any non-public information in this document.

I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true.

Sign here Ź

Date Typed or Printed Name

Statement Approved Board of District Court Judges September 22, 2010 Page 2 of 3
Revised April 15, 2015
 Certificate of Service
I certify that I served a copy of this document on the following people.
Served at this Served on
Person’s Name Method of Service Address this Date
[ ] 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
(Other Party or Attorney) and discretion residing there.)
[ ] Mail
[ ] Hand Delivery
(Clerk of Court) [ ] 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 Ź
Date
Typed or Printed Name

Statement Approved Board of District Court Judges September 22, 2010 Page 3 of 3
Revised April 15, 2015
My Name

Address

City, State, Zip

Phone

Email

I am the [ ] Plaintiff/Petitioner
[ ] Defendant/Respondent
[ ] Attorney for the [ ] Plaintiff/Petitioner [ ] Defendant/Respondent and my
Utah Bar number is _________

In the [ ] District [ ] Juvenile [ ] Justice Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

Memorandum [ ] Supporting
[ ] Opposing

Motion to ______________________
_____________________________________ _______________________________
Plaintiff/Petitioner Case Number
_______________________________
v. Judge
_____________________________________ _______________________________
Defendant/Respondent Commissioner

Instructions:
x You must complete this form before you file it. Court staff cannot complete this form for you.
x Keep a copy of all documents for your records.
x Attend all court hearings.
x Attach the following:
o Additional pages as needed to complete paragraphs that don’t have enough space. Write the
paragraph number on the additional page.
o A copy of any statutes, ordinances, rules or appellate opinions relied upon in your arguments.

Memorandum Template Approved Board of District Court Judges September 22, 2010 Page 1 of 4
Revised April 25, 2014
 o Non-Public Information Form, more fully describing non-public information asked for in this
document.

[ ] By and through my attorney, (Attorney, check here if you are appearing for your client.)

I say as follows:

(1) The motion [ ] is [ ] is not supported by the law because: (Cite and attach a
copy of any statutes, ordinances, rules or appellate opinions that support/oppose the motion. Explain why
they support/oppose the motion. Make your arguments in clear, simple sentences. Make each point a
separate paragraph. Number the paragraphs. Arrange the paragraphs logically. Type your statements or
print them clearly. You may take up to 10 pages double-spaced to make your arguments.)

Memorandum Template Approved Board of District Court Judges September 22, 2010 Page 2 of 4
Revised April 25, 2014
I have not included any non-public information in this document.
I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true.

Sign here Ź
Date
Typed or Printed Name

Memorandum Template Approved Board of District Court Judges September 22, 2010 Page 3 of 4
Revised April 25, 2014
 Certificate of Service
I certify that I served a copy of this document on the following people.
Served at this Served on
Person’s Name Method of Service Address this Date
[ ] 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
(Other Party or Attorney) and discretion residing there.)
[ ] Mail
[ ] Hand Delivery
(Clerk of Court) [ ] 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 Ź
Date
Typed or Printed Name

Memorandum Template Approved Board of District Court Judges September 22, 2010 Page 4 of 4
Revised April 25, 2014
My Name

Address

City, State, Zip

Phone

Email

I am the [ ] Plaintiff/Petitioner
[ ] Defendant/Respondent
[ ] Attorney for the [ ] Plaintiff/Petitioner [ ] Defendant/Respondent and my
Utah Bar number is _________

In the [ ] District [ ] Juvenile [ ] Justice Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

Request to Submit for Decision

[ ] Hearing Requested
_____________________________________ _______________________________
Plaintiff/Petitioner Case Number
_______________________________
v. Judge

_____________________________________ _______________________________
Defendant/Respondent Commissioner

Instructions:
x You must complete this form before you file it. Court staff cannot complete this form for you.
x Keep a copy of all documents for your records.
x Attend all court hearings.
x Attach the following:
o Notice of Hearing (if a hearing has been requested).
o Proposed Findings of Fact, Conclusions of Law and Order on Motion to ____________________.

[ ] By and through my attorney, (Attorney, check here if you are appearing for your client.)

Request to Submit for Decision Approved Board of District Court Judges September 10, 2008 Page 1 of 3
Revised April 15, 2015
I say as follows:

(1) The Motion to __________________________ was filed and served on

______________________ (date).

(2) An opposing statement

[ ] was not filed.
[ ] was filed and served on ___________________ (date).

(3) A reply to the opposing statement

[ ] was not filed.
[ ] was filed and served on ___________________ (date).

(4) A Stipulation
[ ] was not filed.
[ ] was filed and served on ___________________ (date).

(5) [ ] I request a hearing.

[ ] I do not request a hearing.

(6) I request that the motion be submitted for decision because it is now ready for
the court to review and issue a decision.
I have not included any non-public information in this document.
I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true.

Sign here Ź
Date
Typed or Printed Name

Request to Submit for Decision Approved Board of District Court Judges September 10, 2008 Page 2 of 3
Revised April 15, 2015
 Certificate of Service
I certify that I served a copy of this document on the following people.
Served at this Served on
Person’s Name Method of Service Address this Date
[ ] 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
(Other Party or Attorney) and discretion residing there.)
[ ] Mail
[ ] Hand Delivery
(Clerk of Court) [ ] 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 Ź
Date
Typed or Printed Name

Request to Submit for Decision Approved Board of District Court Judges September 10, 2008 Page 3 of 3
Revised April 15, 2015
 Form 11. Answer with Counterclaim and Cross-claim
[Caption and signature block as in Form 1]

I. ANSWER
In answer to the specific allegations of the complaint, defendant A admits, denies
and otherwise alleges as follows:
1. Admits paragraph 1.
2. Denies paragraph 2.
3. Lacks sufficient information to answer paragraph 3 and therefore denies
paragraph 3.
First Affirmative Defense
Plaintiff's claim is barred by Utah Code Ann. § _________, the applicable statute of
limitations.

Second Affirmative Defense

Plaintiff is not entitled to the relief sought in the complaint because plaintiff has failed
to mitigate its damages.

Third Affirmative Defense

Plaintiff is not entitled to the relief sought in the complaint because plaintiff has
entered into an accord and satisfaction with this defendant.

II. COUNTERCLAIM
Defendant A counterclaims against plaintiff as follows: (state counterclaim)

III. CROSS-CLAIM
Defendant A cross-claims against defendant B as follows: (state cross-claim)
 Form 12. Third Party Complaint
[Caption and signature block as in Form 1]

1. On __________, third party defendant issued an insurance policy (the "Policy")

indemnifying third party plaintiff against negligence claims arising from the use of third
party plaintiff's automobile.
2. Plaintiff's complaint in this action alleges that on ________, while the Policy was
in force, third party plaintiff negligently drove his automobile causing an accident with
plaintiff. The complaint, a copy of which is attached hereto as Exhibit A, seeks general
and special damages from third party plaintiff.
3. Third party plaintiff demanded indemnification under the Policy for plaintiff's
claims, but third party defendant refused the demand.
4. Based upon the foregoing facts, third party defendant is liable to third party
plaintiff for all or part of what plaintiff may recover from third party plaintiff.
Wherefore, third party plaintiff requests judgment against third party defendant for
any amount recovered by plaintiff against third party plaintiff.
My Name

Address

City, State, Zip

Phone

Email

I am the [ ] Plaintiff/Petitioner
[ ] Defendant/Respondent
[ ] Attorney for the [ ] Plaintiff/Petitioner [ ] Defendant/Respondent and my
Utah Bar number is

In the District Court of Utah

Judicial District County

Court Address

Summons (To be served in Utah)

Plaintiff/Petitioner
Case Number
v.
Judge
Defendant/Respondent Commissioner

The State of Utah to (party’s name):

You are summoned and required to answer the attached complaint/petition. Within 21
days after service of this summons, you must file your written, signed answer with the
clerk of the court at the court address shown above. A blank answer form is available
on the court’s website: www.utcourts.gov/howto/answer/.

Within that 21 days you must also mail or deliver a copy of your answer to the party or
the party’s attorney at the address shown above. If you fail to do so, judgment by default
may be taken against you for the relief demanded in the complaint or petition.

Summons - In Utah Approved Board of District Court Judges Page 1 of 2

Revised February 24, 2015
The court’s Finding Legal Help web page (www.utcourts.gov/howto/legalassist/)
provides information about the ways you can get legal help, including the Self-Help
Center, reduced-fee attorneys, limited legal help and free legal clinics.

Date Sign here Ź

Typed or printed name

Summons - In Utah Approved Board of District Court Judges Page 2 of 2

Revised February 24, 2015