Cover Sheet for Civil Actions

Interpretation. If you do not speak or understand English, Interpretación. Si usted no habla o entiende el Inglés
contact the court at least 3 days before the hearing or contacte al tribunal por lo menos 3 días antes de la audiencia
mediation, and an interpreter will be provided. o mediación y le proveerán un intérprete.

Civil Cover Sheet Revised May 9, 2017 Page 1

 Cover Sheet for Civil Actions
Plaintiff/Petitioner (First) Defendant/Respondent (First)

Name Name

Address Address

City, State, Zip City, State, Zip

Phone Email Phone Email

First Plaintiff/Petitioner’s Attorney* First Defendant/Respondent’s Attorney*

Name Name

Bar Number Bar Number

---------------------------------------------------------------------------------- ----------------------------------------------------------------------------
Plaintiff/Petitioner (Second) Defendant/Respondent (Second)

Name Name

Address Address

City, State, Zip City, State, Zip

Phone Email Phone Email

Second Plaintiff/Petitioner’s Attorney* 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: $92.50  Damages $2001 - $9,999

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

Civil Cover Sheet Revised May 9, 2017 Page 2

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

Petition for Name Change Approved November 19, 2004 Page 1 of 2

Revised July 26, 2017
Fee Case Type
$50  Petition for Adjudication of Priority to
Funds on Trustee's Sale

Petition for Name Change Approved November 19, 2004 Page 1 of 2

Revised July 26, 2017
Name

Address

City, State, Zip

Phone

Email

I am [ ] Petitioner
[ ] Petitioner’s Attorney (Utah Bar #:__________)

In the District Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

Petition for Name Change & Gender

In the Matter of the Name Change of:
Marker Change
____________________________________
_______________________________
_ Case Number
Petitioner
_______________________________
Judge

Petitioner states as follows:

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

(2) The name on my birth certificate is:

Petition for Name Change Approved November 19, 2004 Page 1 of 2

Revised July 26, 2017
 First name

Middle name (if any)

Surname

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

First name

Middle name (if any)

Surname on birth certificate

Married surname (if any)

(4) I want to change my name because:

(5) I do not know any reason why I should not be allowed to change my name.
(6) Except for this petition, I am not involved in any court actions or proceedings.
(7) I am not on probation or parole.
(8) I am not barred as a sex offender under Utah Code 77-41-105(9), or as a child
abuse offender under Utah Code 77-43-105(7) from changing my name. I am
filing a Certification Regarding Offender Registry completed by the Utah
Department of Corrections showing that there were no search results for my
name.
(9) I am not changing my name to avoid creditors or anyone else with a claim
against me.
(10) My name change will not affect any right, title, or interest of anyone else, and I do
not know of anyone else who should be notified of this petition.

Signature ►
Date
Printed Name

On this date, I certify that _________________________________________________________ (name)

who is known to me or who presented satisfactory identification, in the form of
______________________________________________________ (form of identification), has, while in my
presence and while under oath or affirmation, voluntarily signed this document and declared that it is true.

Petition for Name Change Approved November 19, 2004 Page 1 of 2

Revised July 26, 2017
 Signature ►
Date
Printed name (Court Clerk or Notary Public)

Notary Seal

Petition for Name Change Approved November 19, 2004 Page 1 of 2

Revised July 26, 2017
Name

Address

City, State, Zip

Phone

Email

I am the [ ] Petitioner
[ ] Attorney for the Petitioner and my Utah Bar number is _________

In the District Court of Utah

__________ Judicial District ________________ County
Court Address ______________________________________________________

Request for Hearing on Petition for

Name Change & Gender Marker
In the Matter of the Name Change of: Change

_______________________________
____________________________________ Case Number
_
Petitioner _______________________________
Judge

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

Request for Hearing on Petition for Name and Page 1 of 1

Gender Change
 Sign here ►

Date Typed or Printed Name

Request for Hearing on Petition for Name and Page 1 of 1

Gender Change
Name

Address

City, State, Zip

Phone

Email

In the District Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

Order on Petition for Name Change

In the Matter of the Name Change of: & Gender Marker Change

_______________________________
____________________________________ Case Number
_
_______________________________
Petitioner
Judge

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

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

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

First name

Middle name (if any)

Surname

Order on Petition for Name and Gender Change

THE COURT FINDS:

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

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

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

________________________________________________________________

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

THE COURT CONCLUDES:

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

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

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

THE COURT ORDERS:

(1) The Petition is

[ ] granted
[ ] denied

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

First name

Middle name (if any)

Surname on birth
certificate

Married surname (if any)

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

Sign here ►

Order on Petition for Name and Gender Change

Date Judge

Order on Petition for Name and Gender Change

 Certificate of Service
I certify that I served a copy of this Order on Petition for Name Change on the following people (only if
there were other interested parties in this case).

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.)
(Interested Party or
[ ] Left at home (With person of suitable
Attorney) 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.)
(Interested Party or
[ ] Left at home (With person of suitable
Attorney) age and discretion residing there.)

Sign here ►

Date Typed or Printed Name

Order on Petition for Name and Gender Change