Name  

 
Address (omit if safeguarded) 

 
City, State, Zip (omit if safeguarded) 

 
Phone  (omit if safeguarded) 

 
Email (omit if safeguarded) 

I am   [  ]  Petitioner 

 
 
 
 
 
 
 
 
 

[  ]  Respondent 
[  ]  Respondent’s Attorney   

[  ]  Person Acting as Parent 
[  ]  Person Acting as Parent's Attorney          

(Utah Bar #:__________) 

[  ]  Petitioner’s Attorney 
 
[  ]  Petitioner’s Licensed Paralegal Practitioner  
[  ]  Person Acting as Parent’s Licensed Paralegal Practitioner 

[  ]  Respondent’s Licensed Paralegal Practitioner 
(Utah Bar #:__________) 

In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the Matter of (select one) 
 

[  ]  the Marriage of (for a divorce with or without 
children, annulment, separate maintenance, or 
temporary separation case) 

[  ]  the Children of (to establish custody, parent-

time or child support) 

[  ]  the Parentage of the Children of (for a 

paternity case) 

____________________________________ 
(name of Petitioner) 

and  

 

Request to Register Foreign  

[  ]  Child Custody or Parent-Time 

Order (UCCJEA) 
Utah Code 78B-13-101 et seq. 

[  ]  Support or Income Withholding 

Order (UIFSA) 
Utah Code 78B-14-101 et seq. 

_______________________________ 
Case Number 

____________________________________ 
(name of Respondent) 
____________________________________________ 
Other parties (if any) 

_______________________________ 
Judge 

_______________________________ 
Commissioner (domestic cases) 

1. 

Request 

I want to register the attached orders (Choose all that apply.): 

[  ]  Child custody or parent-time order.  

1250FAJ Approved September 10, 
2019 / Revised May 1, 2022 
 

Request to Register Foreign Child Custody or Parent-
Time Order, or Support or Income Withholding Order 

Page 1 of 7 

 

The district court has jurisdiction. (Utah Code 78B-13-305) (UCCJEA) 

[  ]   Support or income withholding order.   

The district court has jurisdiction. (Utah Code 78B-14-602) (UIFSA) 

[  ]   Combined child custody or parent-time order and support or income 

withholding order.   

Safeguarded address 

2. 

 

3.  

Requesting party 

I am a (Choose one.): 

[  ]  My health, safety, or liberty, or that of my child would be jeopardized by 

including my contact information. I have provided it in a separate Non-public 
Information – Safeguarded Address form instead of listing my contact 
information in paragraph 3 below. (Utah Code 78B-13-209(5)). 

[  ]  parent of the children listed below.  

[  ]  person who has been acting as a parent to the children listed below. 

Name of Minor 

Date of Birth 

Address (street, city, state, ZIP) 
(omit if safeguarded) 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.  
 

Order to be registered  
(Choose one.) 

[  ]  There is only one order. It has never been modified. The original order 

described below is attached. 

[  ]  The original order has been modified. The most recent modified order is the 
controlling order. The original order and most recently modified order are 
described below and attached. 

1250FAJ Approved September 10, 
2019 / Revised May 1, 2022 
 

Request to Register Foreign Child Custody or Parent-
Time Order, or Support or Income Withholding Order 

Page 2 of 7 

 

[  ]  There are multiple orders. I want the court to determine which order or 

orders are controlling. They are attached. (This can only be used if registering a 
support or income withholding order.) 

Original order: 
[  ]  I believe this is the controlling order. 

 
[  ] Petitioner 
[  ] Respondent 

Most recently modified order: 
[  ]  I believe this is the controlling order. 

 

 

 

 

 

 

 

 

Name of 
order: 
Name of 
Court: 
Address 
of Clerk of 
Court: 

Case 
Number: 

Date 
Signed: 

Payor: 

Name of 
order: 
Name of 
Court: 
Address 
of Clerk of 
Court: 

Case 
Number: 

Date 
Signed: 

Payor: 

 
[  ] Petitioner 
[  ] Respondent 

 

State 

Phone Number of 
Clerk of Court: 

Case Name 

Signed by Judge: 

Monthly Amount  $ 

State 

Phone Number of 
Clerk of Court: 

Case Name 

Signed by Judge: 

Monthly Amount  $ 

 

 

 

 

 

 

 

 

1250FAJ Approved September 10, 
2019 / Revised May 1, 2022 
 

Request to Register Foreign Child Custody or Parent-
Time Order, or Support or Income Withholding Order 

Page 3 of 7 

 

Ordered to  
(choose all that apply) 

[  ] Have custody 
[  ] Have parent-time 

[  ] Pay support 
[  ] Receive support 

[  ] Have custody 
[  ] Have parent-time 

[  ] Pay support 
[  ] Receive support 

[  ] Have custody 
[  ] Have parent-time 

[  ] Pay support 
[  ] Receive support 

[  ] Have custody 
[  ] Have parent-time 

[  ] Pay support 
[  ] Receive support 

State 

Phone Number of 
Clerk of Court: 

Case Name 

Signed by Judge: 

Monthly Amount  $ 

 

 

 

 

Name 

Social Security 
Number 

Address (street, city, 
state, ZIP) 
(omit if protected) 

Other modified order: 
[  ]  I believe this is the controlling order. 

 

 

 

 

Name of 
order: 
Name of 
Court: 
Address 
of Clerk of 
Court: 

Case 
Number: 

Date 
Signed: 

Payor: 

 
[  ] Petitioner 
[  ] Respondent 

5. 

Party information 

 

 

 

 

 

 

 

 

Parent 

Parent 

Person Acting as Parent 

erson Receiving 

Payments  

      P

 

1250FAJ Approved September 10, 
2019 / Revised May 1, 2022 
 

Request to Register Foreign Child Custody or Parent-
Time Order, or Support or Income Withholding Order 

Page 4 of 7 

 

(If you are registering a support or income withholding order, complete paragraphs 6-10.)  

Information about the person required to pay (6-8) 

6. 

[  ]  Employer  

Name 

Address (street, city, state, ZIP) 

7. 

[  ]  Other sources of income  

Name 

Address (street, city, state, ZIP) 

8. 

[  ]  Property 

Non-exempt property in Utah (if known): 

Description 

Location (Address: street, city, state, ZIP) 

9. 

[  ]  Others affected by this action 

Other people or agencies whose rights may be affected in this action: 

Name 

Address (street, city, state, ZIP) 

10. 

[  ]  Past-due child support 

The amount of past-due support (arrears) or consolidated arrears under 
multiple orders) is $________________. (If none, enter zero.) 

 

1250FAJ Approved September 10, 
2019 / Revised May 1, 2022 
 

Request to Register Foreign Child Custody or Parent-
Time Order, or Support or Income Withholding Order 

Page 5 of 7 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

etitioner or 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). 

ttorney or Licensed Paralegal Practitioner of record (if applicable) 

Signature ► 

Printed Name 

Signature ► 

Printed Name 

 

 

 

 

  P

 

    A

 

Date 

Date 

1250FAJ Approved September 10, 
2019 / Revised May 1, 2022 
 

Request to Register Foreign Child Custody or Parent-
Time Order, or Support or Income Withholding Order 

Page 6 of 7 

 

 

 

 

Certificate of Service 

I certify that I filed with the court and am serving a copy of this Request to Register Foreign Child Custody 
or Parent-Time Order, or Support or Income Withholding Order on the following people. 

Person’s Name 

Service Method 

Service Address 

Service 
Date 

 

 

 

 

 
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.) 

 

 

 

Signature ► 

Printed Name 

 

 

1250FAJ Approved September 10, 
2019 / Revised May 1, 2022 
 

Request to Register Foreign Child Custody or Parent-
Time Order, or Support or Income Withholding Order 

Page 7 of 7