SMALL CLAIMS COMPLAINT

(AFFIDAVIT & SUMMONS – UTAH)
[// GUIDANCE: This template is drafted for use in Utah justice courts (or the small-claims department of the district court). Adjust the caption to match the specific court in which the action will be filed.]

I. DOCUMENT HEADER

IN THE [☐ JUSTICE COURT / ☐ DISTRICT COURT, SMALL-CLAIMS DEPARTMENT]
IN AND FOR [__] COUNTY, STATE OF UTAH
| | |
|------------------------|--------------------------------------------------|
| Plaintiff(s): | [PLAINTIFF FULL LEGAL NAME] |
| | [STREET ADDRESS] |
| | [CITY, STATE ZIP] |
| Defendant(s): | [DEFENDANT FULL LEGAL NAME] |
| | [STREET ADDRESS] |
| | [CITY, STATE ZIP] |
| Case No.: | ___ |
| Judge: | ______ |

TITLE:
SMALL CLAIMS COMPLAINT (AFFIDAVIT & SUMMONS) FOR MONETARY DAMAGES
[Utah Code Ann. § 78A-8-102; Utah R. Small Claims P. 1–13]

Effective Date of Filing: ___ / ___ / 20___

II. DEFINITIONS

[// GUIDANCE: Most small-claims pleadings do not require a separate definitions section. Include only if specialized terms are used. Delete Section II if not needed.]

1. “Claim” means the monetary demand asserted herein, exclusive of court costs, interest, and allowable fees.
2. “Small Claims Limit” means the jurisdictional ceiling of $15,000 set forth in Utah Code Ann. § 78A-8-102(1)(a).

III. OPERATIVE ALLEGATIONS

1. Parties.
   a. Plaintiff [NAME] is an individual/business entity residing or doing business in [COUNTY], Utah.
   b. Defendant [NAME] is an individual/business entity residing or doing business in [COUNTY], Utah.

2. Jurisdiction & Venue.
   a. This Court has subject-matter jurisdiction under Utah Code Ann. § 78A-8-102 because the amount in controversy does not exceed $15,000 and the relief sought is exclusively monetary.
   b. Venue is proper in this County under Utah R. Civ. P. 6 (Small Claims) because [select one]:
   i. Defendant resides or does business in this County; or
   ii. The events giving rise to this Claim occurred in this County.

3. Statement of Claim.
   a. On or about ___ / ___ / 20, Defendant became indebted to Plaintiff in the principal amount of $[__] arising from [describe transaction: e.g., breach of contract, unpaid loan, property damage, returned check, etc.].
   b. Despite written demand dated ___ / ___ / 20, Defendant has failed and refused to pay the amount owed.

4. Damages Sought.
   a. Principal Amount: $[_]
   b. Pre-Judgment Interest [if applicable]: $[_]
   c. Court Filing Fee: $[_]
   d. Service of Process Fee: $[_]
   e. Total Claim: $[__] (does not exceed $15,000)
   [// GUIDANCE: Utah small-claims courts routinely allow statutory interest and court costs. Attorney fees are not recoverable unless expressly provided by statute or written agreement.]

IV. REPRESENTATIONS & WARRANTIES

Plaintiff certifies, represents, and warrants as follows:

1. The Claim is not for punitive damages, injunctive relief, or any non-monetary remedy.
2. The total monetary relief sought, exclusive of allowable court costs and interest, is within the Small Claims Limit.
3. The Claim is timely and not barred by any statute of limitation.
4. No other action involving these parties and this Claim is pending in any court.

V. PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully requests judgment against Defendant as follows:

1. Principal Damages: $[__];
2. Pre-Judgment Interest: at the statutory rate from ___ / ___ / 20___ until the date of judgment;
3. Court Costs & Service Fees: as allowed by law;
4. Post-Judgment Interest: at the statutory rate until the judgment is satisfied in full; and
5. Such other and further relief as the Court deems just and proper.

VI. APPEAL RIGHTS NOTICE

Either party may appeal a final judgment to the district court within 30 days after entry of judgment. The appeal will be heard de novo (anew) pursuant to Utah R. Small Claims P. 12. No right to a jury trial exists in small-claims proceedings.

VII. VERIFICATION (Utah Code Ann. § 78A-8-102(2))

I, [PLAINTIFF NAME], declare under criminal penalty under the law of the State of Utah that the foregoing is true and correct.

Date: ___ / ___ / 20 ______
[PLAINTIFF NAME], Plaintiff

VIII. SUMMONS TO DEFENDANT

TO: [DEFENDANT NAME & ADDRESS]

YOU ARE HEREBY SUMMONED to appear for trial in the above-entitled action on the day of ___, 20, at :___ ☐ a.m. / ☐ p.m. at the [COURT NAME & ADDRESS].

1. Failure to Appear may result in a default judgment for the relief demanded in this Complaint.
2. You may file any written answer or counterclaim before the hearing, but written pleadings are not required in small-claims actions.
3. Bring with you all documents or witnesses necessary to defend this action.

Date of Issuance: ___ / ___ / 20___

Clerk of the Court / Deputy

IX. CERTIFICATE OF SERVICE

I hereby certify that on ___ / ___ / 20___ a true and correct copy of the foregoing SMALL CLAIMS COMPLAINT (AFFIDAVIT & SUMMONS) was served upon [DEFENDANT NAME] as follows:

☐ Personal service by [NAME], a person over 18 years of age and not a party to this action.
☐ Certified mail with return receipt requested, postage prepaid.
☐ Other (specify): _______.

[NAME OF SERVER]

X. ATTORNEY/PRO SE SIGNATURE BLOCK

Respectfully submitted,

[ATTORNEY NAME], Bar No. [#####]
[LAW FIRM NAME]
[ADDRESS]
[PHONE] | [EMAIL]
Attorney for Plaintiff – OR – ☐ Pro Se Plaintiff

OPTIONAL ATTACHMENTS

1. Copy of written contract, invoice, or promissory note.
2. Demand letter dated ___ / ___ / 20___.
3. Itemized statement of damages.

[// GUIDANCE: Attach only documents that substantiate the Claim. Over-attachment can delay processing.]

QUICK-REFERENCE CHECKLIST

✔ Claim ≤ $15,000 (exclusive of costs & interest)
✔ Monetary relief only (no injunctions, punitive damages, or replevin)
✔ Venue & jurisdiction paragraphs completed
✔ Verification signed under penalty of perjury
✔ Summons section includes hearing date/time supplied by clerk
✔ Proper service method selected and documented

[// GUIDANCE: File the original with the court clerk. Serve Defendant promptly. Diary the 30-day appeal window post-judgment.]

This template is provided for general informational purposes and is not legal advice. Adapt to the specific facts and consult the Utah Rules of Small Claims Procedure and local court rules before filing.