Free Pro Se Guide - Procedures for Filing Petition for Writ of Certiorari - Utah


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PRO SE GUIDE PROCEDURES FOR FILING PETITION FOR WRIT OF CERTIORARI
Basic information about filing a petition for writ of certiorari with the Utah Supreme Court

The court's office hours are 8:00 a.m. to 5:00 p.m., Monday through Friday except on official state and federal holidays. Utah Supreme Court Appellate Clerks' Office 450 South State, Fifth Floor PO Box 140210 Salt Lake City, Utah 84114-0210 (801) 578-3900
F:\home\CLERKS\FORMS\PROSE-PKT-Cert.wpd

5/12/09 Table of Contents

What is a Petition for Writ for Certiorari? ............................................ 2 Representing Yourself .......................................................................... 2 Utah Rules of Appellate Procedure ...................................................... 2 Fees ....................................................................................................... 2 Service .................................................................................................. 3 Change of Address................................................................................ 3 Filing ..................................................................................................... 3 Stages in a Petition for Writ of Certiorari............................................. 4 Sample Certificate of Service Form...................................................... 5 Appellate Rules 45 - 51 ...................................................................6-10 Appellate Rule 27 ..........................................................................10-11 Checklist for Petitions for Certiorari .................................................. 12 Affidavit and Application for Waiver of Court Fees .....................13-17

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What is a Petition for Writ of Certiorari? A petition for writ of certiorari is a request to the Utah Supreme Court to review a decision of the Utah Court of Appeals. The Supreme Court can choose to grant or deny the petition. If the petition is denied, the decision of the Court of Appeals stands. Representing Yourself You can choose to represent yourself in court. People who represent themselves in court are called "Pro Se" or "Self-Represented" litigants. Think carefully before deciding to represent yourself: the process takes time and patience and can be confusing. You will be expected to know and follow the same rules that attorneys do. The court provides some resources, but court staff cannot give you legal advice. You will have to figure out most things on your own. Review and advice from an attorney is strongly recommended. Keep in mind that as a pro se litigant, you can only represent yourself. The law prohibits you from speaking for another person, company, or entity such as a club or association that includes other individuals. Utah Rules of Appellate Procedure The Utah Rules of Appellate Procedure (also called Appellate Rules) explain the procedure in appeals cases. The Appellate Rules specify the deadlines for filing documents, spell out how documents must be formatted, and provide other important information. Be sure to read and follow these rules carefully. The current Appellate Rules are available on the court's website at www.utcourts.gov/resources/rules/. The Appellate Rules are also published in Utah Court Rules Annotated, which is available at the law libraries listed below, and at some public libraries. Utah State Law Library 450 S. State Street, Rm. W13 Salt Lake City 801-238-7990 www.utcourts.gov/lawlibrary /

University of Utah S.J. Quinney Law Library 332 South 1400 East University of Utah Campus 801-581-6438 www.law.utah.edu/library/

Brigham Young University Howard W. Hunter Law Library BYU Campus, Provo 801-422-3593
http://lawlib.byu.edu/

Fees The filing fee for a petition for writ of certiorari is $225. You may pay by cash, check or money order. You can ask the court to waive the filing fee if you can show you meet certain financial/income guidelines. You must submit an Affidavit and Application for Waiver of Court Fees to make the request. The form is available on the court's website at www.utcourts.gov/resources/forms/. Even if a waiver is approved by the court, you will still have to pay other costs associated with your appeal. For example, if additional transcripts are needed, you must pay a court reporter or transcriber to prepare them. If you need copies of original documents in your case file, you must pay 25 per page.

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Service Service is delivering a copy of a legal document to the person (or entity) on the other side of your case. Appellate Rule 21 governs service, and says that service may be personal (hand-delivered) or by mail. In some situations you may also serve by fax see the Filing section, below, for details. You must serve all papers you file on all other parties to the appeal. If the other side has an attorney, you serve the papers on the attorney. If the other side does not have an attorney, you serve the papers to their last known address. In a misdemeanor case, you serve the city or county attorney. In a felony case, you serve the attorney general. A certificate of service must be attached to all papers filed with the court. The certificate of service tells the court when and how you served the other side, the names of those you served, and the addresses where they were served. The court will not read your documents or act on your case until you have shown you served all parties. A sample certificate of service is provided in the forms appendix.

Change of Address Notification You must notify the Supreme Court immediately in writing if you have a change of address during the appeal process.
Filing To "file" a paper is to give it to the clerks' office to add to the case record. You can file papers with the court in person or by mail. You can also file by fax, subject to the following rules: Documents must be 10 pages or less. Exception: Petitions for interlocutory appeal, petitions for writ of certiorari and petitions for review may not be filed by fax, no matter how long they are. After you fax the document, you must also file the original document with the court within 5 business days of sending the fax. The court can treat the document as ineffective and untimely if it does not receive the original within that time. A fax filing is considered "received" when it is stamped by the clerks' office. A document can only be stamped during regular office hours (8:00 a.m. to 5:00 p.m., weekdays). A fax received after 5:00 p.m. will not be stamped as received until the next business day. At the same time you fax the document to the court, you must also send it by fax, hand-delivery or mail to all other parties to the appeal. Your fax to the court must include a certificate of service telling the court that you have served all the other parties, how you served them, and that the document was originally filed with the court by fax. The time for filing a response to a document filed by fax runs from the date the document was faxed to the court. If you fax your documents to the court, you assume the risk for any problems that may occur, such as the court's phone system being out of order, the court's fax machine running out of paper or being out of order. You may want to contact the court after faxing the document to make sure your fax arrived safely. Appellate Clerks' Office Fax Number: 801-578-3999

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The Stages of a Petition for Writ of Certiorari Petition for Writ of Certiorari Filed Due 30 days after the entry of the final decision by the Court of Appeals. You can request an additional 30 days to file a motion for extension of time to file a petition up to 30 days after what would have been the due date for the petition under Appellate Rule 48. Response to Petition for Certiorari The Petition is Taken Under Advisement Due 30 days after the petition is filed in the Supreme Court. A reply to the response may be filed, but the court will not delay the processing of the petition to wait for a reply. The case is closed. The clerk's office will issue a writ directing the record to be sent to this court. The case proceeds under Appellate Rules 24 - 30. Due 40 days after record is filed. Court will send notice of due date. Due 30 days after petitioner's brief is filed. The case is set for the next available oral argument date. Optional, and due 30 days after filing of respondent's brief.

If the Petition is Denied ... If the Petition is Granted ...

Petitioner's Brief (Blue) Respondent's Brief (Red) Case is Now at Issue Petitioner's Reply Brief (Gray) Oral Argument Before the Court Case is Taken Under Advisement Court Issues Opinion Petition for Rehearing Remittitur Issued (The record is returned to the trial court)

Optional, and due 14 days after opinion is issued. Issued no earlier than 14 days after the opinion is issued, or if a petition for rehearing is filed, no earlier than 5 days after the petition for rehearing is resolved.

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CERTIFICATE OF SERVICE

I, ________________(your name) hereby certify that on _________________(date) I served a copy of the attached _______________________________(name of document) upon the party(ies) listed below by [mailing it by [first class mail][personal delivery](Circle one) to the following address(s):

____________________________ ____________________________ ____________________________ ____________________________

____________________________ ____________________________ ____________________________ ____________________________

By: ____________________________ Signature Dated this ____________________________.

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Utah Rules of Appellate Procedure Title VII. Jurisdiction on Writ of Certiorari to Court of Appeals Rule 45. Review of judgments, orders, and decrees of court of appeals. Unless otherwise provided by law, the review of a judgment, an order, and a decree (herein referred to as "decisions") of the Court of Appeals shall be initiated by a petition for a writ of certiorari to the Supreme Court of Utah. Rule 46. Considerations governing review of certiorari. (a) Review by a writ of certiorari is not a matter of right, but of judicial discretion, and will be granted only for special and important reasons. The following, while neither controlling nor wholly measuring the Supreme Court's discretion, indicate the character of reasons that will be considered: (1) When a panel of the Court of Appeals has rendered a decision in conflict with a decision of another panel of the Court of Appeals on the same issue of law; (2) When a panel of the Court of Appeals has decided a question of state or federal law in a way that is in conflict with a decision of the Supreme Court; (3) When a panel of the Court of Appeals has rendered a decision that has so far departed from the accepted and usual course of judicial proceedings or has so far sanctioned such a departure by a lower court as to call for an exercise of the Supreme Court's power of supervision; or (4) When the Court of Appeals has decided an important question of municipal, state, or federal law which has not been, but should be, settled by the Supreme Court. (b) After a petition for certiorari has been filed, the panel that issued the opinion of the Court of Appeals may issue a minute entry recommending that the Supreme Court grant the petition. Parties shall not request such a recommendation by motion or otherwise. Rule 47. Certification and transmission of record; joint and separate petitions; crosspetitions; parties. (a) Joint and separate petitions; cross-petitions. Parties interested jointly, severally, or otherwise in a decision may join in a petition for a writ of certiorari; any one or more of them may petition separately; or any two or more of them may join in a petition. When two or more cases are sought to be reviewed on certiorari and involve identical or closely related questions, it will suffice to file a single petition for a writ of certiorari covering all the cases. A cross-petition for writ of certiorari shall not be joined with any other filing. (b) Parties. All parties to the proceeding in the Court of Appeals shall be deemed parties in the Supreme Court, unless the petitioner notifies the Clerk of the Supreme Court in writing of the petitioner's belief that one or more of the parties below have no interest in the outcome of the petition. A copy of such notice shall be served on all parties to the proceeding below, and a party noted as no longer interested may remain a party by notifying the clerk, with service on the other parties, that the party has an interest in the petition. c) Motion for certification and transmission of record. A party intending to file a petition for certiorari, prior to filing the petition or at any time prior to action by the Supreme Court on the petition, may file a motion for an order to have the Clerk of the Court of Appeals or the clerk of the trial court certify the record, or any part of it, and provide for its transmission to the Supreme Court. Motions to certify the record prior to action on the petition by the Supreme Court should Page 7
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rarely be made, only when the record is essential to the Supreme Court's proper understanding of the petition or the brief in opposition and such understanding cannot be derived from the contents of the petition or the brief in opposition, including the appendix. If a motion is appropriate, it shall be made to the Supreme Court after the filing of a petition but prior to action by the Supreme Court on the petition. In the case of a stay of execution of a judgment of the Court of Appeals, such a motion may be made before the filing of the petition. Thereafter, the Clerk of the Supreme Court or any party to the case may request that additional parts of the record be certified and transmitted to the Supreme Court. Rule 48. Time for petitioning. (a) Timeliness of petition. A petition for a writ of certiorari must be filed with the Clerk of the Supreme Court within 30 days after the entry of the final decision by the Court of Appeals. The docket fee shall be paid at the time of filing the petition. (b) Refusal of petition. The clerk will refuse to receive any petition for a writ of certiorari which is beyond the time indicated in paragraph (a) of this rule or which is not accompanied by the docket fee. c) Effect of petition for rehearing. The time for filing a petition for a writ of certiorari runs from the date the decision is entered by the Court of Appeals, not from the date of the issuance of the remittitur. If a petition for rehearing is timely filed by any party, the time for filing the petition for a writ of certiorari for all parties runs from the date of the denial of rehearing or of the entry of a subsequent decision entered upon the rehearing. (d) Time for cross-petition. (1) A cross-petition for a writ of certiorari must be filed: (A) within the time provided in Subdivisions (a) and ) of this rule; or (B) within 30 days of the filing of the petition for a writ of certiorari. (2) Any cross-petition timely only pursuant to paragraph (d)(1)(B) of this rule will not be granted unless a timely petition for a writ of certiorari of another party to the case is granted. (3) The docket fee shall be paid at the time of filing the cross-petition. The clerk shall refuse any cross-petition not accompanied by the docket fee. (4) A cross-petition for a writ of certiorari may not be joined with any other filing. The clerk of the court shall refuse any filing so joined. (e) Extension of time. The Supreme Court, upon a showing of excusable neglect or good cause, may extend the time for filing a petition or a cross-petition for a writ of certiorari upon motion filed not later than 30 days after the expiration of the time prescribed by paragraph (a) or ) of this rule, whichever is applicable. Any such motion which is filed before expiration of the prescribed time may be ex parte, unless the Supreme Court otherwise requires. Notice of any such motion which is filed after expiration of the prescribed time shall be given to the other parties. No extension shall exceed 30 days past the prescribed time or 10 days from the date of entry of the order granting the motion, whichever occurs later. (f) The number of copies to be filed and served shall be the same as provided in Rule 26. Rule 49. Petition for writ of certiorari. (a) Contents. The petition for a writ of certiorari shall contain, in the order indicated: (1) A list of all parties to the proceeding in the court whose judgment is sought to be reviewed, except where the caption of the case in the Supreme Court contains the names of all parties. Page 8
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(2) A table of contents with page references. (3) A table of authorities with cases alphabetically arranged and with parallel citations, agency rules, court rules, statutes, and authorities cited, with references to the pages of the petition where they are cited. (4) The questions presented for review, expressed in the terms and circumstances of the case but without unnecessary detail. The statement of the questions should be short and concise and should not be argumentative or repetitious. General conclusions, such as "the decision of the Court of Appeals is not supported by the law or facts," are not acceptable. The statement of a question presented will be deemed to comprise every subsidiary question fairly included therein. Only the questions set forth in the petition or fairly included therein will be considered by the Supreme Court. (5) A reference to the official and unofficial reports of any opinions issued by the Court of Appeals. (6) A concise statement of the grounds on which the jurisdiction of the Supreme Court is invoked, showing: (A) the date of the entry of the decision sought to be reviewed; (B) the date of the entry of any order respecting a rehearing and the date of the entry and terms of any order granting an extension of time within which to petition for certiorari; C) reliance upon Rule 47), where a cross-petition for a writ of certiorari is filed, stating the filing date of the petition for a writ of certiorari in connection with which the cross-petition is filed; and (D) the statutory provision believed to confer jurisdiction on the Supreme Court. (7) Controlling provisions of constitutions, statutes, ordinances, and regulations set forth verbatim with the appropriate citation. If the controlling provisions involved are lengthy, their citation alone will suffice and their pertinent text shall be set forth in the appendix referred to in subparagraph (10) of this paragraph. (8) A statement of the case. The statement shall first indicate briefly the nature of the case, the course of the proceedings, and its disposition in the lower courts. There shall follow a statement of the facts relevant to the issues presented for review. All statements of fact and references to the proceedings below shall be supported by citations to the record before and to the opinion of the Court of Appeals. (9) With respect to each question presented, a direct and concise argument explaining the special and important reasons as provided in Rule 46 for the issuance of the writ. (10) An appendix containing, in the following order: (A) copies of all opinions, including concurring and dissenting opinions, and all orders, including any order on rehearing, delivered by the Court of Appeals in rendering the decision sought to be reviewed; (B) copies of any other opinions, findings of fact, conclusions of law, orders, judgments, or decrees that were rendered in the case or in companion cases by the Court of Appeals and by other courts or by administrative agencies and that are relevant to the questions presented. Each document shall include the caption showing the name of the issuing court or agency, the title and number of the case, and the date of its entry; and C) any other judicial or administrative opinions or orders that are relevant to the questions presented but were not entered in the case that is the subject of the petition. Page 9
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If the material that is required by subparagraphs (7) and (10) of this paragraph is voluminous, they may be separately presented. (b) Form of petition. The petition for a writ of certiorari shall comply with the form of a brief as specified in Rule 27. c) No separate brief. All contentions in support of a petition for a writ of certiorari shall be set forth in the body of the petition, as provided in subparagraph (a)(9) of this rule. The petitioner shall not file a separate brief in support of a petition for a writ of certiorari. If the petition is granted, the petitioner will be notified of the date on which the brief in support of the merits of the case is due. (d) Page limitation. The petition for a writ of certiorari shall be as short as possible, but may not exceed 20 pages, excluding the subject index, the table of authorities, any verbatim quotations required by subparagraph (a)(7) of this rule, and the appendix. (e) Absence of accuracy, brevity, and clarity. The failure of a petitioner to present with accuracy, brevity, and clarity whatever is essential to a ready and adequate understanding of the points requiring consideration will be a sufficient reason for denying the petition.

Rule 50. Brief in opposition; reply brief; brief of amicus curiae. (a) Brief in opposition. Within 30 days after service of a petition the respondent shall file an opposing brief, disclosing any matter or ground why the case should not be reviewed by the Supreme Court. Such brief shall comply with Rules 26(b), 27 and, as applicable, 49. (b) Page limitation. A brief in opposition shall be as short as possible and may not, in any single case, exceed 20 pages, excluding the subject index, the table of authorities, any verbatim quotations required by Rule 49(a)(7), and the appendix. c) Objections to jurisdiction. No motion by a respondent to dismiss a petition for a writ of certiorari will be received. Objections to the jurisdiction of the Supreme Court to grant the writ of certiorari may be included in the brief in opposition. (d) Distribution of filings. Upon the filing of a brief in opposition, the expiration of the time allowed therefor, or express waiver of the right to file, the petition and the brief in opposition, if any, will be distributed by the clerk for consideration. However, if a cross-petition for a writ of certiorari has been filed, distribution of both it and the petition for a writ certiorari will be delayed until the filing of a brief in opposition by the cross-respondent, the expiration of the time allowed therefor, or express waiver of the right to file. (e) Reply brief. A reply brief addressed to arguments first raised in the brief in opposition may be filed by any petitioner, but distribution under paragraph (d) of this rule will not be delayed pending the filing of any such brief. Such brief shall be as short as possible, but may not exceed five pages. Such brief shall comply with Rules 26(b) and 27. (f) Brief of amicus curiae. A brief of an amicus curiae may be filed only if accompanied by written consent of all parties, by leave of the Supreme Court granted on motion, or at the request of the Supreme Court. A motion for leave shall identify the interest of the applicant and shall state the reasons why a brief of an amicus curiae is desirable. Except as all parties otherwise consent, an amicus curiae shall file its brief within the time allowed the party whose position it will support, unless the Supreme Court for cause shown shall grant leave for later filing, in which event it shall specify within what period an opposing party may answer. Such brief shall comply with Rules 26(b), 27, and, as applicable, 49. The brief may not exceed 20 pages, excluding the subject index, the table of authorities, any verbatim quotations required by Rule 49(a)(7), and the appendix. Page 10
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Rule 51. Disposition of petition for writ of certiorari. (a) Order after consideration. After consideration of the documents distributed pursuant to Rule 50, the Supreme Court will enter an order denying the petition or granting the petition in whole or in part. The order shall be decided summarily, shall be without oral argument, and shall not constitute a decision on the merits. The clerk shall not issue a formal writ unless directed by the Supreme Court. (b) Grant of petition. (1) Whenever an order granting a petition for a writ of certiorari is entered, the Clerk of the Supreme Court forthwith shall notify the Clerk of the Court of Appeals and counsel of record. (2) If the record has not previously been filed, the Clerk of the Supreme Court shall request the clerk of the court with custody of the record to certify it and transmit it to the Supreme Court. (3) The clerk shall file the record and give notice to the parties of the date on which it was filed and the date on which petitioner's brief is due. (4) Rules 24 through 31 shall govern briefs, argument, and disposition of the petition for writ of certiorari. In applying Rules 24 through 31, the petitioner shall stand in the place of the appellant and the respondent in the place of the appellee. In lieu of providing the citation or statements required in Rules 24(a)(5)(A) and (B), the statement of the issues presented for review as required by Rule 24(a)(5) shall include, for each issue, a statement and citation showing that the issue was presented in the petition for certiorari or fairly included therein. c) Denial of petition. Whenever a petition for a writ of certiorari is denied, an order to that effect will be entered, and the Clerk of the Supreme Court forthwith will notify the Court of Appeals and counsel of record.

Rule 27. Form of briefs. (a) Paper size; printing margins. Briefs shall be typewritten, printed or prepared by photocopying or other duplicating or copying process that will produce clear, black and permanent copies equally legible to printing, on opaque, unglazed paper 8 inches wide and 11 inches long, and shall be securely bound along the left margin. Paper may be recycled paper, with or without de-inking. The printing must be double spaced, except for matter customarily single spaced and indented. Margins shall be at least one inch on the top, bottom and sides of each page. Page numbers may appear in the margins. (b) Typeface. Either a proportionally spaced or mono-spaced typeface in a plain, roman style may be used. A proportionally spaced typeface must be 13-point or larger for both text and footnotes. Examples are CG Times, Times New Roman, New Century, Bookman and Garamond. A mono-spaced typeface may not contain more than ten characters per inch for both text and footnotes. Examples are Pica and Courier. c) Binding. Briefs shall be printed on both sides of the page, and bound with a compact-type binding so as not unduly to increase the thickness of the brief along the bound side. Coiled plastic and spiral-type bindings are not acceptable.

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(d) Color of cover; contents of cover. The cover of the opening brief of appellant shall be blue; that of appellee, red; that of intervenor, guardian ad litem, or amicus curiae, green; that of any reply brief, or in cases involving a cross-appeal, the appellant's second brief, gray; that of any petition for rehearing, tan; that of any response to a petition for rehearing, white; that of a petition for certiorari, white; that of a response to a petition for certiorari, orange; and that of a reply to the response to a petition for certiorari, yellow. All brief covers shall be of heavy cover stock. There shall be adequate contrast between the printing and the color of the cover. The cover of all briefs shall set forth in the caption the full title given to the case in the court or agency from which the appeal was taken, as modified pursuant to Rule 3(g), as well as the designation of the parties both as they appeared in the lower court or agency and as they appear in the appeal. In addition, the covers shall contain: the name of the appellate court; the number of the case in the appellate court opposite the case title; the priority number of the case, as set forth in Rule 29; the title of the document (e.g., Brief of Appellant); the nature of the proceeding in the appellate court (e.g., Appeal, Petition for Review); the name of the court and judge, agency or board below; and the names and addresses of counsel for the respective parties designated as attorney for appellant, petitioner, appellee, or respondent, as the case may be. The names of counsel for the party filing the document shall appear in the lower right and opposing counsel in the lower left of the cover. (e) Effect of non-compliance with rules. The clerk shall examine all briefs before filing. If they are not prepared in accordance with these rules, they will not be filed but shall be returned to be properly prepared. The clerk shall retain one copy of the non-complying brief and the party shall file a brief prepared in compliance with these rules within 5 days. The party whose brief has been rejected under this provision shall immediately notify the opposing party in writing of the lodging. The clerk may grant additional time for bringing a brief into compliance only under extraordinary circumstances. This rule is not intended to permit significant substantive changes in briefs.

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Form 9. Checklist for Petitions for Certiorari - Rules 45 through 51. Deadlines for Filing 1. Petition: 30 days after entry of decision or decision on petition for rehearing. 2. Cross-petition: Within time permitted for petition or 30 days after petition is filed. Cross-petition may not be joined with other filing. 3. Brief in opposition: 30 days after service of petition. 4. Reply brief: No deadline. 5. Extension for petition or cross-petition: By motion showing excusable neglect filed within 30 days of the expiration of the original deadline. Number of Copies 1. Seven copies filed with the Supreme Court - one with an original signature; reproduced signature on other copies. 2. Two copies served upon counsel for all parties to the petition. Length 1. Petition and brief in opposition: 20 pages excluding index, table of authorities, and required verbatim quotations. 2. Reply brief: Five pages. Size, Binding, Print, and Cover Requirements 1. Same as for briefs filed under Utah R. App. P. 24, 26, and 27. Content Requirements 1. List of all parties unless all parties appear in the caption. 2. Table of contents with page references. 3. Table of authorities with page references: (a) cases listed alphabetically with parallel citations; (b) rules; ) statutes; (d) other authorities. 4. Questions presented for review stated in the circumstances of the case. 5. Citation to the opinion of the Court of Appeals. 6. Statement of the jurisdiction of the Supreme Court: a. date of entry of decision to be reviewed; b. date of entry of order respecting a petition for rehearing or date of entry and terms of order respecting an extension of time in which to file the petition; c. date of filing of petition when filing a cross-petition; d. statute that confers jurisdiction upon the Supreme Court. 7. Constitutional provisions, statutes, ordinances, and rules set out verbatim or by citation alone if set out verbatim in the appendix. 8. Statement of the case: a. nature of the case; b. course of proceedings and dispositions in other courts; c. statement of facts supported by citations to the record and the opinion of the Court of Appeals. 9. Concise argument of the special and important reasons for issuance of the writ. Rules 46 and 49. 10. Appendix a. opinions and orders of the Court of Appeals; b. findings of fact, conclusions of law, orders and judgments rendered by the Court of Appeals or any other court or agency; c. other judicial or administrative decisions relating to the case.

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_____________________________ (Name) _____________________________ (Address) _____________________________ (City) _____________________________ (Telephone)

Court Decision
_________ Date of approval _________ Date of denial ____________________ (Initials of judge or clerk)

In the Utah Court of Appeals / Utah Supreme Court (circle one)
450 S State St. Salt Lake City, UT 84111

_________________________, Appellant / Appellee (circle one)
vs. ______________________________,

( name)

AFFIDAVIT AND APPLICATION FOR WAIVER OF COURT FEES Appellate Case No. __________________ Case No. ____________________ Judge _______________________

( name)

Appellant / Appellee (circle one)

I solemnly swear or affirm that the following is true: Due to my poverty, I am unable to bear the expenses of the legal proceedings that I am about to begin, and I believe that I am entitled to the relief sought in these proceedings. To obtain a waiver of court fees, I am providing the following financial information:
NOTE: If Section1 below applies and is completed, then you do not need to complete Section 2. Section 2 must be completed if Section 1 does not apply.

SECTION 1:

I receive public assistance under Temporary Assistance to Needy Families (TANF),
Supplemental Security Income (SSI), Medicaid, or General Assistance (GA).

I am being represented in this action by Utah Legal Services, or by a volunteer attorney
designated by Utah Legal Services. I qualified for such representation because my income at the time my case was accepted did not exceed 125% of federal poverty guidelines.

I am being represented in this action by Legal Aid Society of Salt Lake. I qualified for such
representation because my income at the time my case was accepted did not exceed 150% of federal poverty guidelines.

Rev. Feb. 2008

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SECTION 2: Answer all the following questions only if Section I above does not apply. Income:
I was born on: If I am applying for my child, my child's name is: I have the following job(s). My employer's name and address is: If I am applying for my child, my child's date of birth is: Monthly pay before deductions: $ _____________ (If you do not have a job, write "None" in this space.) I have income from sources other than employment. Include such sources as rental income, money or other support from non-household family members, etc.) I receive this much per month from government programs. (Include such sources as social security benefits, worker's compensation, veterans noneducational benefits, housing, food, other living allowances, etc.) I share a household with other adults, some of whom have jobs and share the cost of household expenses. The names and my relationship to these household members are listed in this box: Name: ___________________ Relation: ____________ Name: ___________________ Relation ____________ I receive this much alimony per month: Source of income Monthly income, non-wage $ _____________ Source of income Monthly income from government programs $ _____________ Monthly pay before deductions of other adults in household: $ ______________ $ ______________ $ _____________
Monthly pay after deduction of other adults in household:

Monthly pay after deductions: $ _____________

$ _____________ $ _____________

Assets
I have this much money in cash, in the bank, in stocks or bonds, or in other available sources:


$_____________ $_____________

Other people or organizations owe me this much money:

If Applicant is a prisoner, how much is held in Applicant's trust account? (Certificate Regarding Inmate Account must be filed.)

$_____________

Rev. Feb. 2008

Page 15

I own or am buying a home, land, or other real property, and vehicles or other personal property as

listed below .
Property (home, land, vehicles, etc.) and location Home $___________ Land and other real property $___________ Cars, trucks, or other vehicles $___________ Other personal property $___________ Balance owed Value

Debt
I owe the following debts: To whom owed Amount $_______ $_______ $_______ To whom owed Amount $______ $______ $______

Expenses In an average month, I spend money for the following items:
Amount Food $ ________ Clothing $ _________ Cost of housing $ _________ Transportation $ _________ Electricity $ _________ Uninsured medical expenses Health insurance $________ Telephone $________ $________ Water $________ Education expense for children Other (list) Other (list) $_______ $_______ $_______ Gas $________ Child care $_______ Amount Child support Amount $_______

The following people depend on me for support:
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Name

Age

Relationship

Name

Age

Relationship

Lives in household with me: Yes or No?

The following facts also indicate that I am unable to pay court fees and costs: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Being sworn, I state that I have read this Affidavit and Application for Waiver of Court Fees, and the statements in it are true and correct to the best of my knowledge. I realize that an intentionally false statement could subject me to prosecution for perjury.

DATED: __________________________ _____________________________ Appellant NOTARY CLAUSE ________________________________, Appellant, is personally known to me or presented satisfactory proof of identity to me. After being sworn and while under oath, Appellant stated that he or she was acting voluntarily, had read and understood the preceding document, and that the contents were true. Appellant then signed the document in my presence. Signed on _________________, 20____. X______________________________________ Notary Public / Court Clerk

(Notary Seal) Information for applicants seeking waiver of court fees and costs:

Rev. Feb. 2008

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The Court will evaluate an applicant's financial inability to pay court fees and costs. This decision is left to the judge's discretion. However, to get an idea as to whether your income and assets are so low that you qualify for this waiver, please review the annual federal poverty guidelines, which are listed at the following website: www.utcourts.gov/resources.

Rev. Feb. 2008

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