<p>Name</p><p>Address</p><p>City, State, Zip</p><p>Phone</p><p>Email</p><p>I am [ ] Plaintiff/Petitioner [ ] Defendant/Respondent [ ] Plaintiff/Petitioner’s Attorney [ ] Defendant/Respondent’s Attorney (Utah Bar #:______)</p><p>In the [ ] District [ ] Juvenile [ ] Justice Court of Utah</p><p>______Judicial District ______County Court Address ______</p><p>Certificate of Service (Utah Rule of Civil Procedure 5) ______Plaintiff/Petitioner Case Number v. ______Judge ______Defendant/Respondent Commissioner (domestic cases)</p><p>I certify that I served a copy of ______(document name), which was filed with the court on ______(date). I delivered the document as indicated below.</p><p>1021GEJ Approved January 22, 2018 Certificate of Service Page 1 of 3 Served at this Served on Person’s Name Method of Service Address this Date [ ] Mail [ ] Hand Delivery [ ] E-filed [ ] 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 [ ] E-filed [ ] 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 [ ] E-filed [ ] 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.)</p><p>Signature ► Date Printed Name</p><p>1021GEJ Approved January 22, 2018 Certificate of Service Page 2 of 3 Certificate of Service I certify that I filed with the court and served a copy of this Certificate of Service on the following people.</p><p>Served at this Served on Person’s Name Method of Service Address this Date [ ] Mail [ ] Hand Delivery [ ] E-filed [ ] 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 [ ] E-filed [ ] 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 [ ] E-filed [ ] 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.)</p><p>Signature ► Date Printed Name</p><p>1021GEJ Approved January 22, 2018 Certificate of Service Page 3 of 3</p>