Keep a Copy of All Documents for Your Records

My Name

Address

City, State, Zip

I am the [ ] Plaintiff/Petitioner [ ] Defendant/Respondent [ ] Attorney for the [ ] Plaintiff/Petitioner [ ] Defendant/Respondent and my Utah Bar number is ______

In the District Court of Utah

______Judicial District ______County

Court Address ______

Stipulation

______Case Number Plaintiff/Petitioner ______v. Judge

______Defendant/Respondent

Instructions:  You must complete this form before you file it. Court staff cannot complete this form for you.  Keep a copy of all documents for your records.

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

I say as follows:

Stipulation Approved Board of District Court Judges May 4, 2011 Page 1 of 3 Revised April 15, 2015 (1) [ ] I have received and read the Motion to Renew Judgment and its supporting documents. I understand the claims and the request that the judgment in this case be renewed for the amount of $______. I understand that, when the judgment is signed, I will owe the creditor that amount.

(2) [ ] I understand that I have the right to contest the claims and to have a judge decide the issues.

(3) [ ] Understanding these things, I voluntarily:

[ ] enter my appearance;

[ ] admit the claims; and

[ ] stipulate that the court may enter the attached Findings of Fact, Conclusions of Law and Order at any time and without further notice.

I have not included any non-public information in this document.

I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true.

Sign here ► Date Typed or Printed Name

Stipulation Approved Board of District Court Judges May 4, 2011 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.) [ ] Left at home (With person of suitable age (Other Party 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

Stipulation Approved Board of District Court Judges May 4, 2011 Page 3 of 3 Revised April 15, 2015