ity, State, Zip 

 
Name 

ddress 

hone 

mail 

  A

  C

  P

  E

I am   [  ]  Plaintiff or employee of plaintiff 

[  ]  Plaintiff’s Attorney 

  (Utah Bar #:__________) 

In the ______________________________  Justice Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

_____________________________________ 
Plaintiff 
v. 

_____________________________________ 
Defendant 

Small Claims Affidavit and 
Summons 
Online Dispute Resolution Case 

_______________________________ 
Case Number 

_______________________________ 
Judge 

This form is for small claims cases filed in justice courts using Online Dispute 
Resolution only. Forms for all other justice courts can be found here: 
www.utcourts.gov/howto/smallclaims/ 

1.  

Defendant owes me the following amounts: 
Claim described in paragraph 2.  
(Include any prejudgment interest accrued to date and applicable 
attorney fees. Attach statute or contract authorizing claim for 
attorney fees.) 

lus, the amount I paid to file this claim.  

lus, the amount I paid to serve claim.  

Equals, the total amount I am seeking. 

$ 

$ 

$ 

$ 

  P

  P

 

SC Aff ODR  Approved 6/18/2018 / 
Revised June 28, 2019 

Small Claims Affidavit and Summons  
Online Dispute Resolution Case 

Page 1 of 5 

plus prejudgment interest, if qualified.  

2. 

The events happened on _________________________ (date). My claim is 
based on the following facts: 

3. 

Choose one: 

 

 

[  ]  Defendant resides within the jurisdiction of the court.  

[  ] The events happened within the jurisdiction of the court.. 

4. 

[  ]  I am not suing a government entity. I am not suing a government employee 

for the employee’s on-the-job conduct. 

5. 

[  ]  I am not suing on a claim that has been assigned to me. 

I declare under criminal penalty under the law of Utah that everything stated in this document is true. 

Signed at ______________________________________________________ (city, and state or country). 

Signature ► 

Printed Name 

 

 

             

 
Date 

 

 

SC Aff ODR  Approved 6/18/2018 / 
Revised June 28, 2019 

Small Claims Affidavit and Summons  
Online Dispute Resolution Case 

Page 2 of 5 

To: 

 

 

 

 

 

 

 

 

 

 

 

 

Defendant Name and Address 

 

Defendant Name and Address 

 

Summons 

 

 

       

        

 

 

 

Notice to the Defendant 

This court uses online dispute resolution (ODR) to settle small claims cases.  
 

  Within 14 days of receiving this Affidavit, you must register at 

https://pubapps.utcourts.gov/OnlineDisputeResolutionWEB to try to settle this 
case.  

 

If you do not register within 14 days, judgment may be entered against you for 
the total amount claimed. The plaintiff could garnish your paycheck or take your 
property to pay the debt. 

 

If you are unable to participate in the online process, see below. 

In this small claims case, instead of going to trial at the courthouse at a specific date 
and time, you and the plaintiff will work with a third person (facilitator) to reach a 
solution.  A facilitator is a neutral person trained to help people resolve disputes.   

A small claims case has been started 
against you. 

Se  ha  iniciado  un  caso  de  reclamos  menores 
contra usted. 

Read the Affidavit 
The Affidavit explains what the other 
party is asking for. Read it carefully. 

Lea la declaración jurada 
La declaración jurada explica lo que la otra parte 
está pidiendo. Léala detenidamente. 

  Register for Online Dispute 
Resolution (ODR)  

 
Inscripción a la Resolución de disputas 
por internet(ODR, por sus siglas en inglés)  

  Within 14 days of receiving the 
Affidavit, go to 
www.utcourts.gov/smallclaimsodr 
and register for ODR. 

  Dentro de 14 días después de haber 
recibido la declaración jurada, ingrese a 
www.utcourts.gov/smallclaimsodr  e 
inscríbase a ODR. 

SC Aff ODR  Approved 6/18/2018 / 
Revised June 28, 2019 

Small Claims Affidavit and Summons  
Online Dispute Resolution Case 

Page 3 of 5 

 

  Para inscribirse necesitará el número de 
caso y su nombre tal como figura en la 
declaración jurada para acceder a su caso. 

  Después de que se inscriba, se asignará 
un facilitador de reclamos menores a su 
caso. Existen varios resultados posibles: 

  

  

 Si acepta que le debe dinero al 
demandante y usted está de acuerdo con 
el monto adeudado, el facilitador puede 
ayudarle a establecer un plan de pago. 

 Si acepta que le debe dinero al 
demandante pero usted no está de acuerdo 
con el monto adeudado, el facilitador puede 
ayudarle a llegar a un acuerdo sobre el 
monto adeudado. 

 Si no llegan a un acuerdo, usted todavía 
tiene derecho a ir a juicio. 

 

  To register, you will need the 
case number and your name as it is 
listed on the Affidavit to access your 
case.  

  After you register, a small claims 
facilitator will be assigned to your 
case. There are several possible 
outcomes: 

 If you agree you owe the plaintiff 
money and you agree on the 
amount owed, the facilitator can 
help you set up a payment plan. 

 

 If you agree you owe the plaintiff 
money but disagree about the 
amount owed, the facilitator can 
help you come to an agreement on 
the amount owed. 

 If you don’t settle, you still have 
the right to go to trial.  

Asking to be excused from ODR 

Solicitud para que se le exima de ODR 

If you: 

Si usted: 

  need ADA assistance, 

  don’t speak English, or 

necesita ayuda de ADA, 

no habla inglés, o 

 

 

 

  don’t have internet access, 

no tiene acceso al internet, 

you can ask the court to be excused 
from the ODR requirement.  

puede  pedirle  al  juez  que  se  le  exima  del 
requisito de ODR. 

Call the court and ask for the forms. You 
must fill out the forms and return them to 
the court within 7 days of being served 
this document.  

Llame  al  tribunal  y  solicite  los  formularios. 
Deberá  completar  los  formularios  y  devolverlos 
al  tribunal  dentro  de  7  días  de  recibido  este 
documento. 

Trial 

Juicio 

If you can’t come to an agreement with 
the facilitator’s help, or if you have been 
excused from ODR, the case will be 

Si  no  puede  llegar  a  un  acuerdo  con  la  ayuda 
del  facilitador  o  si  ha  sido  eximado  de  ODR,  el 
caso será programado para un juicio. 

SC Aff ODR  Approved 6/18/2018 / 
Revised June 28, 2019 

Small Claims Affidavit and Summons  
Online Dispute Resolution Case 

Page 4 of 5 

 

El tribunal le notificará la fecha, hora y lugar del 
juicio. 

Si  usted  no  se  presenta  al  juicio,  el  juez  puede 
dictar  un  fallo  en  su  contra  por  el  monto  total 
solicitado en la declaración jurada. 

scheduled for trial. 

 

he court will notify you of the date, 

time, and place of the trial.   

If you do not go to the trial, the court can 
enter a judgment against you for the 
total amount requested in this Affidavit. 

  T

Right to Jury Trial 

Derecho a juicio por jurado 

If you want to have a jury trial in this 
case, you must file documents to 
remove the case to district court. See 
the Small Claims web page for 
information about that process, and 
forms: 
www.utcourts.gov/howto/smallclaims/#re
moval2. 

Finding help 
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. 

Si desea tener un juicio por jurado para este 
caso, deberá presentar documentos para 
transferir el caso al tribunal de distrito. Vea la 
página de internet sobre Reclamos menores 
para obtener información sobre ese proceso y 
los formularios: 
www.utcourts.gov/howto/smallclaims/#removal2. 

Cómo encontrar ayuda 
La página de internet del tribunal sobre Cómo 
encontrar ayuda legal 
(www.utcourts.gov/howto/legalassist/) 
proporciona información sobre las formas en 
que puede obtener ayuda legal e incluye lo 
siguiente: el centro de ayuda, abogados con 
tarifas reducidas, asistencia legal limitada y 
talleres legales gratuitos. 

 

 

Signature ► 

Court Clerk 

 

 

SC Aff ODR  Approved 6/18/2018 / 
Revised June 28, 2019 

Small Claims Affidavit and Summons  
Online Dispute Resolution Case 

Page 5 of 5 

 

Date: