JUSTICE COURT, LAS VEGAS TOWNSHIP Clark County, Nevada Name of Plaintiff(s) Case No. Department No. VERSUS Name of Defendant(s) MEMORANDUM OF COSTS AND DISBURSEMENTS Filing ........................................................................................................................... Service of Process ......................................................................................................... Jury Fees ..................................................................................................................... Witness Fees ............................................................................................................... Sheriff's / Constable's Fees ............................................................................................. Record & Certify Judgment ............................................................................................. Garnishment & Execution Fees ........................................................................................ Attorney's Fees ............................................................................................................ $ $ $ $ $ $ $ $ $ TOTAL $ (select appropriate box) [ ] Attorney [ ] Self-Represented Party STATE OF NEVADA ) ) ss. COUNTY OF CLARK ) ___________________________________________________________, being duly sworn (or) under penalty of perjury, states: that Affiant is the attorney for the _________________________________ and has personal knowledge of the above costs and disbursements expended; that the items contained in the above Memorandum are true and correct to the best of this Affiant's knowledge and belief; and that the said disbursements have been necessarily incurred and paid in this action. ___________ ____ Signature of Affiant ____________ ____ ____ _ Attorney For: ___________ ____________ You MUST have this affidavit notarized (block on the left) or sign the unsworn declaration per NRS 53.045 (block on the right): SUBSCRIBED AND SWORN to before me this ____ day of ____________________, 20____. ______________________________________ NOTARY PUBLIC in and for the County of State of Original-File LVJCVL Form-8 Revised 4/12 O R UNSWORN DECLARATION: Per NRS 53.045 "I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct." (Signature): __ _________________________________________ __________________________________ _________________________________________ __. (Typed or printed name): (Date): Copy-Plaintiff Copy-Defendant American LegalNet, Inc. www.FormsWorkFlow.com