Instructions to law enforcement: Do not serve this form with the other papers. You may keep 
this form for your records or destroy it. 
Instructions to the court: Do not place in court file. Provide to law enforcement only. 
 

Service Assistance Form 
This is a Private Record (CJA 4-202.02) 

Document to 
be Served 

 

Case Number 

 

Court Name 
& Address 
Name of Person Requesting Service 

 

 

Information About the Person to be Served 
(Print clearly.) 
Name 

 

Alias/Nickname 

 

Full Social 
Security # 
Race * 

Weight 

Hair color 

 

 

 

 

Date of 
Birth * 
Sex * 

Height 

Eye color 

Special characteristics (tattoos, scars, etc.) 

* Required. If you do not know, write unknown. 

 

 

 

 

 

 

 

 

Home: street address, city, 
state,  zip 

Cell phone 

Home phone 

Best times to reach 

Work: name, street address, 
city, state, zip 

Work phone 

Best times to reach 

Driver’s license number 

Car license number 

Car Make 

Year 

 

 

 

 

 

 

 

 

 

 

 

Model 

Color 

Is this person on probation or parole? 
 
[  ] Yes   [  ] No  [  ] Don’t know 
If known, print the name of the supervising agency and officer and the 
officer’s telephone number. 

Has this person used weapons or been violent in the past?  
 

[  ] Yes  [  ] No  [  ] Don’t know 

 
Service Assistance Form 

Approved Board of District Court Judges May 21, 2008 
Revised July 22, 2021 

Page 1 of 1 



Service Assistance Form

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Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

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About This Form:

• Sourced from legacy.utcourts.gov (2023-03)
• Page(s): 1
• Fields(s): 7
• Average fields per page: 7
• Reading Level: Grade 8
• LIST Grouping(s): Unknown

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