Case Number: ________________  District:_____ 
County: ________________________  State: Utah 
Judge:  __________________________________  
Commissioner: ____________________________   

On Request for Dating Violence  
Protective Order 

otice of Hearing  

  N

etitioner (person who asked for the protective order):  

 

 

 

 

This is a private record. 

To the Respondent (Name):  ____________________________________________________________________________________________   

Go to the court hearing on the date listed below. The Court will make a decision on the 
Petitioner’s Request for Dating Violence Protective Order. If you do not go to the hearing, the Court can 
make orders without hearing your side. You may have an attorney present at the hearing. 

Date:  __________________  Time: ________   a.m.  p.m.    Judicial Officer:   __________________________________   

Address: 

 

 Room: 

 

 

Signed on:  
 

 

 

 

District Court Clerk   

Middle  

Last 

   

 

 

Respondent (person Petitioner asked to be protected from):  
 

Middle  

Last 

isability and Interpreter Services   Assistive listening systems, sign language and oral language interpreter services are 

available at no charge in protective order proceedings. Contact the clerk’s office at least 5 days before your hearing. 

Notice of Hearing On Request for Dating Violence 
Protective Order 
 

Approved Board of District Court Judges May 21, 2008 
Revised August 9, 2018 

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