Fill and Sign the Contact the Court at Least 3 Days Before the Hearing or Form

Cover Sheet for Civil Actions Civil Cover Sheet Revi sed May 9, 2017 Page 1 Interpretation. If you do not speak o r 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 d ías antes de la audiencia o mediación y le proveerán un intérprete. Plaintiff/Petitioner (First) Name Address City, State, Zip Phone Email First Plaintiff/Petitioner ’s Attorney * Name Bar Number ---------------------------------------- ------------------------------------------ Plaintiff/Petitioner (Second ) Name Address City, State, Zip Phone Email Second Plaintiff/Petitioner ’s Attorney * Name Bar Number Defendant/Respondent (First) Name Address City, State, Zip Phone Email First Defendant/Respondent’s Attorney * Name Bar Number --------------------------------------------------------------------- ------- Defendant/Respondent (Second ) Name Address City, State, Zip Phone Email Second Defendant/Respondent’s Attorney * Name 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 :  No monetary damages are requested (URCP 26: Tier 2)  Damages requested are $50,000 or less (URC P 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)  Damages are un specified . Circle one : Tier 1 Tier 2 Tier 3  This case is exempt from URC P 2 6. (E) — — MOTION TO RENEW JUDGMENT — — $37.50  Damages $2000 or less $92.50  Damages $2001 - $9,999 $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 Civil Cover Sheet Revised May 9, 2017 Page 2 Choose  One Fee Case Type — — — — — APPEALp — — — — — $360  Administrat ive Agency Review Sch  Tax Court (Appeal of Tax Commission Decision) Court: Refer to Clerk of Court upon filing. $225  Civil (78A -2-301(1)(h)) (E) $225  Small Claims Trial De N ovo (E) — — — — GENERAL CIVIL — — — — Sch  Civil Rights $0  Civil Stalking (E) $360  Condemnation/Eminent Domain Sch  Contract s Sch  Contract: Employment Discrimination Sch  Contract: Fraud Sch  Debt Collection Sch  Eviction/Forcible Entry and Detainer (E) $360  Extraordinary Relief/Writs $360  Forfeiture of Prop erty (E) Sch  Interpleader Sch  Lien/Mortgage Foreclosure Sch  Miscellaneous Civil $360  Post Conviction Relief: Capital (E) $360  Post Conviction Relief: Non -capital (E) Sch  Property Rights $360  Registry Removal (Gun/White Collar) Sch  Sexual Harassment Sch  Water Rights $360  Wrongful Lien Sch  Wrongful Termination — — — — — — — TORTS — — — —— — — Sch  Automobile Tort Sch  Intentional Tort Sch  Malpractice -Medical Tort Sch  Malpractice -Legal Tort; Other Sch  Premises Liability Sch  Asbestos Sch  Pr oduct Liability (NOT Asbestos) Sch  Slander/Libel/Defamation — — — — DOMESTIC RELATIONS — — — — $0  Protective Orders (E) $310  Marriage Adjudication (T2) $310  Custody/Visitation/Support (T2) $310  Divorce/Annulment (T2)  Check if child support, custod y or parent - time will be part of decree  Check if Temporary Separation filed $8  Vital Statistics §26 -2-25 per form $115  Counterclaim : Divorce/Sep Maint . Fee Case Type $115  Counterclaim: Custody/Visit /Support $155  Counterclaim: Paternity/Grandparent Visitation $100  Domestic Modification (T2) $100  Counter -petition: Domestic Mod. $360  Grandparent Visitation (T2) $360  Paternity/Parentage (T2) $310  Separate Maintenance (T2) $35  Temporary Separation (E) $35  Uniform Child Custody Jurisdiction & Enfor cement Act (UCCJEA) (E) $35  Uniform Interstate Family Support Act (UIFSA) (E) — — — — — JUDGMENTp — — — — — $35  Foreign Judgment (Abstract of ) (E) $50  Abstract of Judgment/Order of Utah Court/Agency (E) $30  Abstract of Judgment/Order of Utah State Tax Commission (E) $35  Judgment by Confession (E) — — — — — PROBATE — — — — — $360  Adoption/Foreign Adoption (T2) $8  Vital Statistics §26 -2-25 per form $360  Conservatorship (T2) $360  Estate Personal Rep (T2) $35  Foreign Probate/Child Custody Doc. (E) $360  Gestational Agreement (T2) $360  Guardianship -Adult (T2) $360  Guardianship -Minor (T2) $35  Guardianship -Disabled Adult Child (T2) $0  Involuntary Commitment (T2) $360  Minor’s Settlement (T2) $360  Name Change (T2) $360  Supervised Administration (T2) $360  Trusts (T2) $360  Unspecified (Other) Probate (T2) — — — — SPECIAL MATTERp — — — — $35  Arbitration Award (E) $0  Determination Competency -Criminal (E) $135  Expungement Petition (E) $0  Hospital Lien (E) $35  Judicial Approval of Document: Not Pa rt of Pending Case (E) $35  Notice of Deposition in Out -of-State Case/Foreign Subpoena (E) $35  Open Sealed Record (E) $50  Petition for Adjudication of Priority to Funds on Trustee's Sale