City, State, Zip 

 
Name 

 
Address 

 
Phone 

 
Email 

 

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

I am   [  ]  Petitioner 

[  ]  Petitioner’s Attorney 
[  ]  Petitioner’s Licensed Paralegal Practitioner 
[  ]  Respondent’s Licensed Paralegal Practitioner   

[  ]  Respondent 
[  ]  Respondent’s Attorney  

(Utah Bar #:__________) 

(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) 

Notice of Modification 
(Utah Code 78B-14-614) 

_______________________________ 
Case Number 

_______________________________ 
Judge 

____________________________________ 
(name of Petitioner) 

_______________________________ 
Commissioner 

and  

 

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

Use this form only if:  

the court modified a support order, 
the original order was issued in another state, 
the order was registered or modified in another state, 

• 
• 
• 
•  or both. 

1134FAJ Approved January 27, 2020 
/ Revised May 1, 2022 
 

Notice of Modification 

Page 1 of 4 

Send a copy of this form with a certified copy of the Order on Petition to Modify to each of those courts. 

To: 

Court that entered the original order 
(Fill out the box below with information about the original order.) 

Case number: 

Case name 

 

Any court in which the original order was registered or modified 
(Fill out the box below with information about the original order.) 

Case number: 

Case name 

 

Title of order: 

Name of court: 

Address of court: 

 

 

Title of order: 

Name of court: 

Address of court: 

Title of order: 

Name of court: 

Address of court: 

Title of order: 

Name of court: 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case number: 

Case name 

 

Case number: 

Case name 

 

State 

 

State 

 

State 

 

State 

 

1134FAJ Approved January 27, 2020 
/ Revised May 1, 2022 
 

Notice of Modification 

Page 2 of 4 

Address of court: 

 

Notice: I have attached a certified copy of an order of the Utah District Court which 
modifies an order entered by or registered in your court. 

 

 

 
Date 

Signature ► 

Printed Name 

 

 

1134FAJ Approved January 27, 2020 
/ Revised May 1, 2022 
 

Notice of Modification 

Page 3 of 4 

 

 

 

 

 

 
Date 

 

I certify that I filed with the court and am serving a copy of this Notice of Modification 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.) 

[  ]  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 

 

 

1134FAJ Approved January 27, 2020 
/ Revised May 1, 2022 
 

Notice of Modification 

Page 4 of 4