The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

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Here is the text we could read:

 
Name 
 
Address 
 
City, State, Zip 
 
Phone 

 
Email  

 

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

I am   [  ]  Plaintiff 

[  ]  Plaintiff’s Attorney 

[  ]  Plaintiff/Petitioner’s Licensed Paralegal Practitioner   

(Utah Bar #:__________) 
(Utah Bar #:__________) 

In the    [  ] District    [  ] Justice    Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

v. 

1. 

 

_____________________________________ 
Plaintiff 

_____________________________________ 
Defendant 

Debt Collection Complaint 

_______________________________ 
Case Number 

_______________________________ 
Judge 

Jurisdiction and Venue  

This is the correct court location to file in because (Choose all that apply): 

[  ]   Defendant is a resident of this county. 

[  ]   Defendant is doing business in this county. 

[  ]   The contract was created in this county. 

[  ]   The contract was to be performed in this county.  

[  ]   Other: ____________________________________________________ 

2. 

Contract or Agreement 

   [  ]  I made the following contract or agreement with the defendant:  
          (Describe what each person agreed to do and the date you made the agreement.) 
 

1001DCJ Approved July 19, 2021 
 

Debt Collection Complaint 

Page 1 of 3 

 [  ]  My claims are based on defendant’s failure to pay a debt owed to someone 
else. I have the right to collect that debt. Defendant had a contract with:  
_______________________________________ (name of creditor).  A 
copy of that agreement is attached as Exhibit A. The defendant agreed to 
the following:  

 

     

     

3. 

The agreement allowed for: 

[  ]  interest in the amount of _________. 

[  ]  attorney fees for the prevailing party. 

[  ]  collection costs.  

Broken Contract or Agreement 
The defendant broke the agreement as follows:  
(Explain how the defendant broke the agreement and what the defendant owes you.) 

 

 

 

 

     

 

 

 

4.  

5. 
 

Request for Relief 
I ask the court to: 

[  ]  Order defendant to pay me $________________. 

[  ]  Order defendant to pay _____% interest, with interest starting on this  

date: ________________. 

[  ]  Order defendant to pay my legal costs and any attorney fees. 

[  ]  Order defendant to pay me a collection fee of $________.  

[  ]  Other:  

 

1001DCJ Approved July 19, 2021 
 

Debt Collection Complaint 

Page 2 of 3 

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). 

Attorney or Licensed Paralegal Practitioner of record (if applicable) 

Signature ► 

Printed Name 

Signature ► 

Printed Name 

 

 

 

 

     

  

Plaintiff 

 
Date 

 
Date 

       

6. 

[  ]  I have attached the following documents in support of this complaint: 

1001DCJ Approved July 19, 2021 
 

Debt Collection Complaint 

Page 3 of 3

Debt Collection Complaint

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from legacy.utcourts.gov (2023-03)
Page(s): 3
Fields(s): 109
Average fields per page: 36
Reading Level: Grade 10
LIST Grouping(s): GO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Debt Collection Complaint

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Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02