Fill and Sign the Affiant Being First Sworn and under Oath Form

Minor’s Name Change: Return of Service, p. 1 Approved: November 19, 2004 (Name) (Address) (City) (Telephone) DISTRICT COURT, COUNTY, UTAH COURT’S ADDRESS: IN THE MATTER OF THE NAME CHANGE OF: ,.(minor’s name) RETURN OF SERVICE A minor.Case No. ____________________Judge _______________________ , Affiant, being first sworn and under oath, (Name of person who served Summons and Petition)deposes and says:1.Affiant resides in County, State of . (name of county) (name of state)Affiant is more than 18 years old and does not have an interest in this action.2.Affiant received the Summons and Petition for this action on . (date) 3.Affiant personally served Respondent with the Summons and Petition in Minor’s Name Change: Return of Service, p. 2 Approved: November 19, 2004 County, on , at (name of county) (date) . At the time of service, (address where served)Affiant knew that the person served was the Respondent in this action.4. At the time of service of the Summons and Petition, Affiant also served Respondent personally with the following additional documents: 5. At the time of service, Affiant wrote the date and place of service on the copy of the Summons left for the person being served. Affiant also signed Affiant’s name and added Affiant’s official title, if an officer, to the Summons.DATED: ____________________________________Affiant (Person serving the Summons) NOTARY CLAUSE , Affiant, is personally known to me or presented satisfactory proof of identity. After being sworn and while under oath, Affiant stated that he or she was acting voluntarily, had read and understood the preceding document, and that the contents were true. Affiant then signed the document in my presence. Signed on , 20 ::. X_________________________________________ Notary Public/Court clerk (Notary Seal)