1 AFFT 2 (Your Name) ______________________ 3 (Address)_________________________ 4 5 _________________________________ (Telephone) _______________________ (Email Address)____________________ 6 Self-Represented 7 DISTRICT COURT 8 CLARK COUNTY, NEVADA 9 _______________________ 10 DEPT NO.: ____________________ 11 12 CASE NO.: ____________________ Plaintiff, vs. _______________________ 13 Defendant. AFFIDAVIT OF SERVICE 14 15 STATE OF NEVADA 16 COUNTY OF CLARK 17 ) ) ss: ) (Name of person who gave the documents to the Defendant, the “Affiant”)____________ 18 19 __________________________, being duly sworn, states that at all times herein Affiant was and 20 is over 18 years of age, not a party to nor interested in the proceeding in which this affidavit is 21 made. 22 That Affiant has a business or home address of (street,city,state,zip) _________________ 23 ______________________________________________________________________________. 24 25 That Affiant’s telephone number is ( 26 That Affiant is not required to be a licensed process server because Affiant is not engaged 27 in business as a process server as defined in NRS 648.014 or Affiant is a licensed process server 28 ) ________________. whose license number is stated below. ©Clark County Family Law Self-Help Center Rev. 7_11 1 Affidavit of Service Generic 7_11.doc ALL RIGHTS RESERVED American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 That Affiant received a copy of the (list the documents) __________________________ ____________________________________ on the check one) That Affiant personally served the ( day of Plaintiff , 20____. Defendant with a copy of the above stated documents on the ___________ day __________________, 20___ at about 5 6 (time) ______ a.m./p.m. by: (check and complete option A or B) 7 8 9 A. Delivering and leaving the documents with said party at (street address) ________ _____________________ (city) ________, (state)_____________, (zip code)________. 10 11 OR 12 B. 13 documents were given to) ____________________________________, who is a person of 14 suitable age and discretion that lives with the above state party at (street address) _______ 15 ______________________ (city) ________, (state)_____________, (zip code)________. Delivering and leaving a copy with (first and last name of person that the 16 17 18 __________________________________________ Signature of Affiant 19 20 __________________________________________ Process Server License Number (If you are not a licensed process server write N/A) 21 22 23 24 25 26 27 SUSCRIBED and SWORN to before me this ______ day of (month) _________, 20___ . _______________________________ NOTARY PUBLIC 28 ©Clark County Family Law Self-Help Center Rev. 7_11 2 Affidavit of Service Generic 7_11.doc ALL RIGHTS RESERVED American LegalNet, Inc. www.FormsWorkFlow.com