Fill and Sign the Counter Affidavit and Summons Form

Counter Affidavit and Summons (Small Claims) Approved Board of Justice Court Judges September 22, 2010 Revised May 10, 2017 Page 1 of 5 Name Address City, State, Zip Phone Email I am the [ ] Defendant [ ] Attorney for the Defendant and my Utah Bar number is __ ____ _ In the Justice Court of Utah __________ Judicial District ________________ County Court Address ________ ______________________________________________ ________________________________ ____ _ Plaintiff v. _____________________________________ Defendant And _____________________________________ Defendant Counter Af fidavit and Summons (Small Claims) ____________ ___________________ Case Number _______________________________ Judge I s wear that the following is true. (1) Plaintiff owes me $ for the claim described in paragraph (2). plus the filing fee of $ plus estimated attorney fee s of (Attach statute or co ntract showing you are a uthorized to claim attorney fees .) for a total of: $ plus prejudgment, if qualified for prejudgment interest. Counter Affidavit and Summons (Small Claims) Approved Board of Justice Court Judges September 22, 2010 Revised May 10, 2017 Page 2 of 5 (2) The events happened on ____ ______ ______ ______ (date) . My claim is based on the following facts. (3) [ ] I am not suing a government entity. I am not suing a government employee for the employee’s on -the -job conduct. (4) [ ] I am not suing on a claim that has been assigned to me. (5 ) [ ] I understand that I may be barred from later bringing any claims a rising out of the event or transaction if the claims are not described in this affidavit . I understand that I have the right to move this case to the district court where I could ask for a jury trial. By deciding to keep this case in the justice court, I waive my right to a jury trial. I have not included any non -public information in this document. Date: Sign here ► Printed Name. Defendant or Defendant’s Agent 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. Date: Sign here ► Notary or Court Clerk Counter Affidavit and Summons (Small Claims) Approved Board of Justice Court Judges September 22, 2010 Revised May 10, 2017 Page 3 of 5 Notary Seal Counter Affidavit and Summons (Small Claims) Approved Board of Justice Court Judges September 22, 2010 Revised May 10, 2017 Page 4 of 5 Summons To : Para : Plaintiff Name and Ad dress Nombre y dirección del Demandante You are summoned to appear at trial to answer the above claim. The trial will be held at the court address shown above. If you fail to appear, judgment may be entered against you for the total amount claim ed . Se le cita a comparecer a juicio para responder al reclamo arriba descrito. El juicio tendrá lugar en la dirección del tribunal que se muestra arriba. Si usted no comparece, se podría dictar un fallo contra usted por el total de la cantidad reclamada. The original trial date (La fecha original para juicio) [ ] has not changed no ha sido cambiada [ ] has been changed to: ha sido cambiada para: Date (Fecha ) Time (Hora ) : [ ] a.m. [ ] p.m. [ ] p.m. Room (Sala ) Judge (Juez ) Notice to the Plaintiff A counter claim has been filed against you. This imposes upon you certain rights and responsibilities. You can find small claims information and instructions at https://www.utcourts.gov/how to/smallclaims/ . 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. Un contrademanda ha sido presentado contra usted. Esto le impone a usted ciertos derechos y obligaciones. Usted puede encontrar información e instrucciones sobre reclamos menores en https://www.utco urts.gov/howto/smallclaims/ . La página del tribunal sobre Como Encontrar Ayuda Legal (www.utcourts.gov/howto/legalassist/ ) proporciona información acerca de las maneras en que usted puede obtener ayuda legal, incluyendo el Centro de Ayuda del tribunal, abogados a precio reducido, ayuda legal limitada y talleres jurídicos gratuitos. Counter Affidavit and Summons (Small Claims) Approved Board of Justice Court Judges September 22, 2010 Revised May 10, 2017 Page 5 of 5 Attendance. You must attend. If you do not attend, the relief requested might be granted. You have the right to be rep resented by a lawyer. Asistencia. Presentarse es obligatorio. Si usted no llegara a presentarse, el remedio solicitado podría ser otorgado. Usted tiene el derecho de que lo represente un abogado. Evidence. Bring with you any evidence that you want the cou rt to consider . Pruebas. Traiga con usted cualquier prueba que quiera que el tribunal tome en cuenta. Interpretation. If you do not speak or understand English, contact court staff at least 3 days before the hearing, and an interpreter will be provided. In terpretación. Si usted no habla ni entiende el Inglés contacte al personal del tribunal por lo menos 3 días antes de la audiencia y le proveerán un intérprete. Disability Accommodation. If you have a disability requiring accommodation, including an ASL int erpreter, contact court staff at least 3 days before the hearing. Atención en caso de incapacidades. Si usted tiene una incapacidad por la cual requiere atención especial, favor de contactar al personal del tribunal por lo menos 3 días antes de la audiencia. Date Sign here ► Court Clerk Certificate of Service I certify that I mailed a copy of thi s document to the following people. Person’s Name Address Date Sent Date Sign here ► Court Clerk