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 [ ] Justice Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

Request to Submit for Decision

_____________________________________
Plaintiff/Petitioner Case Number ___________________
v. Judge _________________________
_____________________________________ Commissioner ___________________
Defendant/Respondent

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

I say as follows:
(1) The clerk of court has issued a Certificate showing the default of the
[ ] Plaintiff/Petitioner
[ ] Defendant/Respondent
(2) I request that the Motion for Default Judgment be submitted for decision because
it is now ready for the court to review and issue a decision.

Request to Submit for Decision Approved Board of District Court Judges January 22, 2010 Page 1 of 3
Revised April 15, 2015
I have not included any non-public information in this document.

Sign here ►
Date
Typed or Printed Name

Request to Submit for Decision Approved Board of District Court Judges January 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.)
(Any Party not in Default [ ] Left at home (With person of suitable age
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

Request to Submit for Decision Approved Board of District Court Judges January 22, 2010 Page 3 of 3
Revised April 15, 2015