Effective: May 2, 2005 ___________________________________ Petitioner’s Name ___________________________________ Address (may be omitted for privacy) ___________________________________ City, State, Zip ___________________________________ Telephone (may be omitted for privacy) IN THE * JUDICIAL DISTRICT COURT * COUNTY, STATE OF UTAH ) _______________________________ ) PETITION FOR CIVIL ) WRONGFUL LIEN INJUNCTION Petitioner, )) vs. ))________________________________ ) Case No. ) Respondent. ) Judge The Petitioner alleges against the Respondent and states as follows: 1. The Petitioner is a victim of a wrongful lien. 2. The Petitioner believes that the Respondent filed, made, recorded or uttered the wrongful lien. 3. The specific acts supporting this allegation are as follows (provide detail on how, where and when the lien was filed, made, recorded or uttered and Respondent’s involvement -use additional pages if necessary):Effective: May 2, 2005 2 ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 4. Attached is a copy of the alleged wrongful lien, affidavits of witnesses, letters from the Respondent, transcripts of conversations, a police report, or other evidence which supports the allegation that this is a wrongful lien. Note: If any court order has been issued concerning the conduct described in paragraph 3, please attach a copy of the order. 5. Check One: [ ] A prior court order concerning the same conduct was issued in the following state, county and/or court___________________________ (Please attach a copy of the order.) [ ] No prior court order concerning the same conduct was issued by any other court. 6. The current address of the Respondent is:_________________________________Effective: May 2, 2005 3 The Petitioner requests an ex parte civil wrongful lien injunction which would include the following: 1. Enjoin the Respondent from making, uttering, recording, or filing any further liens. 2. Order that the wrongful lien be nullified. 3. Order additional relief as follows: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ DATED this______day of_______________, 200___. ________________________________ Petitioner Subscribed and sworn to me on this_______day of ___________, 200___. _________________________________ Court Clerk or Notary Public Serve Respondent at: Street: __________________________ City/Town: __________________________ State, Zip: __________________________