City, State, Zip 

 
Name 

 
Address 

 
Phone 

 
Email 

[  ]  This is a private record 

 
 
 
 
 
 
 
Check your email. You will receive information and 
documents at this email address. 
 

I am   [  ]  Plaintiff/Petitioner 

[  ]  Defendant/Respondent 

[  ]  Plaintiff/Petitioner’s Attorney  [  ]  Defendant/Respondent’s Attorney  (Utah Bar #:__________) 
[  ]  Plaintiff/Petitioner’s Licensed Paralegal Practitioner 
[  ]  Defendant/Respondent’s Licensed Paralegal Practitioner   

(Utah Bar #:__________) 

In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

_____________________________________ 
Plaintiff/Petitioner 

_____________________________________ 
Defendant/Respondent 

_______________________________ 
Judge 

Application for Temporary 
Restraining Order 
(Utah Rule of Civil Procedure 65A) 

[  ]  Hearing Requested 

_______________________________ 
Case Number 

_______________________________ 
Commissioner 

I need immediate relief. There will be irreparable harm (harm that cannot be 
undone) unless the court issues a temporary restraining order. (Describe in detail the 
irreparable harm and why you need immediate relief. Attach additional pages if needed.): 

1401GEJ Approved April 22, 2019 / 
Revised March 21, 2023 

Application for Temporary Restraining Order 

Page 1 of 6 

v. 

1. 

 

 [  ] 

I am attaching the documents listed below as evidence of the irreparable 
harm:  

 

2.  

The irreparable harm would be worse than any harm the other party could suffer 
if this order is issued because: 

3. 

The temporary restraining order, if issued, would not be against the public 
interest because: 

4. 

There is a substantial likelihood that I will prevail on the merits of the underlying 
claim in this case because:  

[  ] 

I gave notice or tried to give notice of the Application for Temporary 
Restraining Order to the opposing party or their attorney in the following 
manner:  

Application for Temporary Restraining Order 

Page 2 of 6 

5.  

Notice (Choose one.)  

1401GEJ Approved April 22, 2019 / 
Revised March 21, 2023 

 

             

   

   

   

[  ] 

I did not give notice and should not be required to give notice of the 
Application for Temporary Restraining Order to the opposing party or their 
attorney. Immediate and irreparable injury, loss or damage will occur if 
notice is provided before the hearing because:  

6. 

[  ]  Children 

 

I ask the court for a temporary restraining order regarding the following minor 
children: (attach additional sheets if needed.) 

Child’s name 
(first, middle and last) 

Month and 
year of birth 

 

 

 

 

The temporary restraining order regarding the children should (choose all that 
apply): 

[  ]  Award   

[  ] petitioner    [  ] respondent     

[  ]  Order 

[  ] petitioner    [  ] respondent      

temporary physical custody of the children listed above. 

to immediately return the children listed above to the custody of  

[  ] petitioner    [  ] respondent      

[  ]  Issue a Writ of Assistance to Remove Children directing law 

enforcement to take custody of the children and deliver them to:   

 [  ] petitioner    [  ] respondent   

1401GEJ Approved April 22, 2019 / 
Revised March 21, 2023 

 

Application for Temporary Restraining Order 

Page 3 of 6 

 

   

 

 

 

 

[  ]  Other orders about the children: 

7.  

[  ] 

I ask the court for a temporary restraining order regarding other issues as 
follows: 

8.  

I understand the court could order me to deposit money or post a bond to cover 
costs, attorney fees or damages resulting from a wrongful order or injunction. 

I should not be required to deposit money or post a bond: 

[  ]  because none of the parties will incur costs, attorney fees or damages as the 

result of a wrongful order or injunction.  

[  ]  for the following substantial reason (Explain.): 

   

   

   

laintiff/Petitioner or Defendant/Respondent  

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). 

 
Date 

Signature ► 

Printed Name 

 

 

ttorney or Licensed Paralegal Practitioner of record (if applicable) 

1401GEJ Approved April 22, 2019 / 
Revised March 21, 2023 

Application for Temporary Restraining Order 

Page 4 of 6 

 

        P

    A

 

1401GEJ Approved April 22, 2019 / 
Revised March 21, 2023 

 

Application for Temporary Restraining Order 

Page 5 of 6 

Signature ► 

Printed Name 

 

 

 

 
Date 

       

 

I certify that I filed with the court and am serving a copy of this Application for Temporary Restraining 
Order on the following people. 

Certificate of Service 

Person’s Name 

Service Method 

Service Address 

Service 
Date 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  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 
[  ]  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  
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

 

 

 

 

 

 

 
Date 

Signature ► 

Printed Name 

 

 

1401GEJ Approved April 22, 2019 / 
Revised March 21, 2023 

Application for Temporary Restraining Order 

Page 6 of 6