IN THE UTAH COURT OF APPEALS

PETITION ON APPEAL 
[CROSS APPEAL ] 

Court of Appeals No. ___________
Juvenile Court No. ________

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STATE OF UTAH  
IN THE INTEREST OF 

_______________,
Children under 18 years of age.

,

Respondent Appellant

Appellant _______________________, through counsel,

, submits

this Petition on Appeal from a final order of the         District Juvenile Court in a child welfare
proceeding pursuant to Utah Rule of Appellate Procedure 55.

1. PARTIES and COUNSEL: The names of the parties involved in this appeal, and the names,
addresses and telephone numbers of their respective attorneys, are as follows:

Appellant:

Appellant’s Counsel:

Appellee:

Appellee’s Counsel:

Children and Dates of Birth:

Guardian ad Litem:

2. ORDER SOUGHT TO BE REVIEWED: This appeal is from an order entered on
_________________, 200____,     a copy of which is attached.   This order:

       Adjudicated the children as abused, neglected, and/or dependent ; 
___ Terminated Appellant’s parental rights to the children                           ;  
-OR- 
___ Dismissed a petition to terminate Appellant’s parental rights to the children

; 

-OR -
___ Other

3. RELIEF APPELLANT SEEKS ON APPEAL (Reversal, remand, other):___________
__________________________________________________________________________

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4. POST-JUDGMENT MOTIONS: The following post-judgment motions have been filed in the
trial court in this matter: __________________________________________________________
______________________________________________________________________________.

5. RELATED APPEALS: Describe any related appeals involving the children (provide name of
case, appellate case number, order being appealed from (i.e. appeal from adjudication, disposition),
or orders previously appealed):______________________________________________________
_______________________________________________________________________________.

6. RELEVANT DATES: The following dates are relevant to this appeal:

a) Date of  removal(s):

b) Date of adjudication(s):

c) Date of disposition(s):

d) Date of permanency hearing(s):

e) Date of order(s) terminating Appellant’s parental rights or dismissing petitions to
terminate Appellant’s parental rights:

f) Date notice of appeal filed:

g) Any other dates relevant to this appeal:

7. STATE THE MATERIAL FACTS AS THEY RELATE TO THE ISSUES
PRESENTED FOR APPEAL (attach separate sheet if necessary):

Note: The fact statement should be concise and should focus on those facts necessary
to a proper understanding of the procedural history of the case and those facts
relevant to the issues Appellant wishes to raise on appeal.

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________.

8. STATE THE LEGAL ISSUES PRESENTED FOR APPEAL, INCLUDING A
STATEMENT AS TO HOW THE ISSUES AROSE AND HOW THEY WERE       
PRESERVED FOR APPEAL:

Note: The issue statement should be concise in nature setting forth specific legal questions. 
General conclusions, such as “the trial court erred” or  “The trial court’s decision is not
supported by the law or the facts” is insufficient.  Include legal authority that both support’s
Appellant’s case and authority contrary to Appellant’s case, if known:

Involves(circle all that apply) personal jurisdiction; subject matter
jurisdiction; sufficiency of evidence; weight of evidence; credibility of
witness; interpretation of evidence; admissibility of evidence;

a) Issue 1

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adequacy of findings; application of law; interpretation of law;
other                .

State Issue:

Describe at what point error occurred:

This issue ____was ____was not preserved.  If issue was preserved state how:             
.
.

State legal authority for issue:

b) Issue 2

Involves(circle all that apply) personal jurisdiction; subject matter
jurisdiction; sufficiency of evidence; weight of evidence; credibility of
witness; interpretation of evidence; admissibility of evidence;
adequacy of findings; application of law; interpretation of law;
other                .

State Issue:

Describe at what point error occurred:

State legal authority for issue:

c) Additional Issues (attach separate sheet)

This issue ____was ____was not preserved.  If issue was preserved state how:             
.

.

.

.

.

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9. ATTACHMENTS: The following necessary attachments are included with this petition (all of
the following must be submitted) :

a) a copy of the order, judgement or decree on appeal

b) a copy of any rulings on post-judgement motions

Appellant requests that the appellate court grant Appellant the relief requested, or, in the
alternative, set this matter for full briefing.

DATED this the        day of                      , 20    .

Appellant (or Counsel) 
Name Address, Phone #

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CERTIFICATE OF SERVICE

I certify that a copy of the attached Petition on Appeal was served upon the party(ies) listed below
by mailing it by first class mail, personal delivery, or fax to the following addresses):

Name:

____________________________

Address:

____________________________

Sent Via:
______Mail (postage prepaid)
______Personal delivery
______Fax #_______________

____________________________

____________________________

Name:

____________________________

Address:

____________________________

Sent Via:
______Mail (postage prepaid)
______Personal delivery
______Fax #_______________

____________________________

____________________________

Name:

____________________________

Address:

____________________________

Sent Via:
______Mail (postage prepaid)
______Personal delivery
______Fax #_______________

____________________________

____________________________

By:

____________________________

Signature

Dated:

____________________________

Revised 8/10/09

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