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Here is the text we could read:

This is a private record. 

rder Establishing Facts of Birth 
and Delayed Registration of Birth 
(Utah Code 26-2-9) 

_____________________________ 

Case Number 

______________________________ 

  O

  _

  _

Judge 
 

 am the 

[  ] Petitioner 
[  ] Attorney for the Petitioner and my Utah Bar number is _________ 

 
In the District Court of Utah 
 
__________ Judicial District ________________ County 
 
Court Address ______________________________________________________ 
 

n the Matter of the Birth of: 

____________________________________ 

The matter before the Court is a Verified Petition for Order Establishing Fact of 

This matter is being resolved by a hearing held on _______________________ (date), 

notice of which was served on the Office of Vital Records and Statistics as required by 

Utah Code 26-2-9(4).  

Order on Petition Establishing Facts of Birth and 
Delayed Registration of Birth (Adult) 

Page 1 of 5 

ame 

ddress 

hone 

mail 

ity, State, Zip 

Petitioner 
 

Birth. 

  N

  A

  C

  P

  E

  I

 

  I

    _

   

 

 

Petitioner 

[  ] was    [  ] was not present. 

[  ] was not represented. 

[  ] was represented by _________________________________________. 

The Office of Vital Records and Statistics [  ] was    [  ] was not present. 

[  ] was represented by _________________________________________. 
 

The court reviewed the following evidence: (List type of document and the date of each) 

     

he court finds: 

1. 

The state registrar denied Petitioner’s request to register a delayed certificate of 

birth. A written statement of the state registrar indicating the reasons for denial of 

registration and all documentary evidence which was summited in support of 

registration was presented to this court. 

2. 

The petitioner: (choose one) 

[  ]  Has not provided sufficient evidence to support the establishment of facts of 

birth and registration of a delayed certificate of birth.  

[  ]   Has provided sufficient evidence to support the establishment of the birth of 

a child in Utah. The facts of birth are as follows: 

Order on Petition Establishing Facts of Birth and 
Delayed Registration of Birth (Adult) 

Page 2 of 5 

 

   

  T

 

 

a.  Petitioner’s birth name is 

(first, middle, and last name). 

______________________________________________________________

b.  Petitioner was born on _________________________ (date). 

c.  Petitioner is [  ]  female  [  ]  male. 

d.  Petitioner was born in _____________________________ (city, county), Utah. 

e.  The time of birth was _________________________. 

f.  The name of Petitioner’s birth father is 

______________________________________________________________ 

(first, middle, and last name). 

g.  Petitioner’s birth father was born on _________________________ (date) in 

_____________________________ (state or country). 

h.  The name of Petitioner’s birth mother is 

______________________________________________________________ 

(first, middle, last and MAIDEN name). 

i.  Petitioner’s birth mother was born on _________________________ (date) in 

_____________________________ (state or country). 

 

 

Order on Petition Establishing Facts of Birth and 
Delayed Registration of Birth (Adult) 

Page 3 of 5 

The court orders: 

The Petition is: 

[  ]   Denied.  

[  ]   Granted and the Office of Vital Records and Statistics is ordered to 

immediately register a delayed certificate of birth in this matter. 

 
Date 

Signature ► 

 

 

Judge 

 

   

 

 

Order on Petition Establishing Facts of Birth and 
Delayed Registration of Birth (Adult) 

Page 4 of 5 

Certificate of Service 

I certify that I filed with the court and served a copy of this Order on Petition Establishing Facts of Birth 
and Delayed Registration of Birth on the following people. 

Person’s Name 

Method of Service 

Served at this 
Address 

Served on 
this Date 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email (Person agreed to service by 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 (Person agreed to service by 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 (Person agreed to service by 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 

 

 

 

 

 

 

Order on Petition Establishing Facts of Birth and 
Delayed Registration of Birth (Adult) 

Page 5 of 5 

 

   

   

 

 

 

 

 

 
Date

Verified Petition for Order Establishing Fact of Birth

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): 5
Fields(s): 150
Average fields per page: 30
Reading Level: Grade 9
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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We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

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users1_address_line_one
city_state_zip
users1_phone_number
email
attorney_petitioner_utah_number
i_am_the
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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Verified Petition for Order Establishing Fact of Birth

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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