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) 

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

Custody Evaluation Settlement 
Conference Report 
(Utah Code of Judicial Administration Rule 4-
903) 

_______________________________ 
Case Number 

_______________________________ 
Judge 

_______________________________ 
Commissioner  

Appointed custody evaluator: _________________________________________________ 

Date of settlement conference: _______________________________________________ 

3.   Minor children 

Name of child 

Date of birth 

 

 

 

 

 

 

Petitioner: ___________________________________________________________________ 

Respondent: ________________________________________________________________ 

1580FAF Approved December 9, 2019 
/ Revised May 1, 2022 

Custody Evaluation Settlement Conference Report 

Page 1 of 3 

and  

1. 

2. 

4. 

5. 

 

 

 

 

 

 

 

6. 

Other parties evaluated: 

Name of person 

Relationship to children 

 

 

 

 

 

 

Guardian ad Litem: __________________________________________________________ 

Petitioner's counsel: _________________________________________________________ 

Respondent's counsel: _______________________________________________________ 

onclusions  

(Use the criteria specified Code of Judicial Administration Rule 4-903) 

 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 

 

 

 

 

 

 

 

 

7. 

8. 

9. 

  C

      I

 

 

 
Date 

1580FAF Approved December 9, 2019 
/ Revised May 1, 2022 

Custody Evaluation Settlement Conference Report 

Page 2 of 3 

I certify that I filed with the court and am serving a copy of this Custody Evaluation Settlement 
Conference Report 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 

 

 

1580FAF Approved December 9, 2019 
/ Revised May 1, 2022 

Custody Evaluation Settlement Conference Report 

Page 3 of 3