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In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

_____________________________________
Petitioner 

v. 

_____________________________________
Defendant/Respondent 

Order on Petition for Judicial Review 
of Final Agency Action 

_______________________________ 
Case Number 

_______________________________ 
Judge 

_______________________________ 
Commissioner 

The matter before the court is a Petition for Review of Final Agency Action in an 
informal adjudicative proceeding pursuant to Utah Code Section 63G-4-402 and 
______________________ (Utah Code or other citation).  

This matter is being resolved by: (Choose all that apply.) 

[  ] The default of     [  ] Petitioner     [  ] Respondent. 

[  ] The stipulation of the parties. 

[  ] The pleadings and other papers of the parties. 

[  ] A trial de novo held on __________________________ (date), notice of which 
was served on all parties. 

Order on Petition for Judicial Review of Final 
Agency Action 

Approved Board of District Court Judges May 18, 2015 

Page 1 of 6 

 

y Name 

ddress 

ity, State, Zip 

  M

  A

  C

  P

  E

hone 

mail 

 

 

[  ] was represented by _______________________ (name). 

Petitioner 

[  ] was    [  ] was not    present. 

[  ] was not represented. 

Respondent 

[  ] was    [  ] was not    present. 

[  ] was represented by _______________________ (name). 

[  ] was not represented. 

Having considered the documents filed with the court, the evidence and the arguments, 
and now being fully informed, 

The Court Finds and Concludes That: 

(1) 

The following facts were established: 

(2) 

[  ] 

The agency action was erroneous for these reasons: 

     

     

[  ] 

The agency action was not erroneous for these reasons: 

Order on Petition for Judicial Review of Final 
Agency Action 

Approved Board of District Court Judges May 18, 2015 

Page 2 of 6 

 

 

 

 

 

or 

     

     

     

     

he Court Orders That: 

(3) 

[  ] 

The petition is dismissed  

[  ]  with prejudice.  

 

[  ]  without prejudice 

(4) 

[  ] 

The agency is ordered to act as required by law as follows: 

[  ] 

The agency is ordered to exercise its discretion as required by law as 
follows: 

[  ] 

The agency action is set aside or modified as follows: 

 

Order on Petition for Judicial Review of Final 
Agency Action 

Approved Board of District Court Judges May 18, 2015 

Page 3 of 6 

  T

 

 

 

 

 

 

[  ] 

The effective date of the agency action is enjoined or stayed as follows: 

[  ] 

The agency action should be remanded for further proceedings as follows: 

(6) 

No additional order is necessary. 

This is the order of the court. Nothing further is required of the parties. 

Sign here ►  

Recommended by Commissioner

 

Sign here ►  

Approved by Judge

 

Order on Petition for Judicial Review of Final 
Agency Action 

Approved Board of District Court Judges May 18, 2015 

Page 4 of 6 

     

     

     

(5) 

[  ] 

Other: 

 

 

 

 

 

 

 
Date 

 
Date 

Approved as to form. 

 
Date 

 
Date 

 

Sign here ►  

Plaintiff/Petitioner or Attorney

 

Sign here ►  

Defendant/Respondent or Attorney

 

Order on Petition for Judicial Review of Final 
Agency Action 

 

Approved Board of District Court Judges May 18, 2015 

Page 5 of 6 

Certificate of Service 

I certify that I served a copy of this document on the following people. 

Person’s Name 

Method of Service 

Served at this 
Address 

Served on 
this Date 

(Other Party or Attorney) 

age and discretion residing there.) 

 

 

 

 

 

 

 

 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Fax (Person agreed to service by fax.) 
[  ]  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 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
 
[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Fax (Person agreed to service by fax.) 
[  ]  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 
[  ]  Fax (Person agreed to service by fax.) 
[  ]  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.) 

Sign here ►  

Typed or Printed Name  

(Clerk of Court) 

(Agency) 

 

 
Date 

 

 

 

Order on Petition for Judicial Review of Final 
Agency Action 

Approved Board of District Court Judges May 18, 2015 

Page 6 of 6

Order on Petition for Judicial Review of Final Agency Action

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): 6
Fields(s): 124
Average fields per page: 20
Reading Level: Grade 9
LIST Grouping(s): Unknown

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.

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Order on Petition for Judicial Review of Final Agency Action

About This Form:

Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02