Case Number: (to be assigned by the Clerk222s Office) Nevada AOC 226 Research & Statistics Unit Revised 03/2019 Pursuant to NRS 3.275 CLARK COUNTY, NEVADA FAMILY COURT COVER SHEET PARTIES: Plaintiff/Petitioner Defendant/Respondent/Co-Petitioner/Protected Person Last Name: Last Name: First Name: Middle Name: First Name: Middle Name: Mailing Address: Mailing Address: City, State, Zip: City, State, Zip: Phone #: Date of Birth: Phone #: Date of Birth: Email Address: Email Address: Attorney Information not applicable Attorney Information not applicable Name: Bar No. Name: Bar No: Address: Address: City, State, Zip: City, State, Zip: Phone #: Phone #: CASE TYPE: (Check only one box only for the primary type of case you are filing) DISSOLUTION MISC. DOMESTIC RELATIONS PETITIONS GUARDIANSHIP OTHER Annulment Divorce 226No minor child(ren) Divorce 226With minor child(ren) Foreign Decree Joint Petition 226No minor child(ren) Joint Petition 226 With minor child(ren) Separate Maintenance Adoption 226Minor Adoption 226Adult Child Custody (non-divorce) Child Support (private party) Mental Health Name Change Paternity Permission to Marry Temporary Protective Order (TPO) Termination of Parental Rights (private party) Termination of Parental Rights (State initiated) Visitation (non-divorce) Other (identify) Guardianship of an Adult Person Estate Person and Estate Guardianship of a Minor Person Estate Person and Estate Guardianship Trust DA Child Support DA 226 UIFSA DA 226 Child Support In State DA Child Dependency DA 226 Abuse/Neglect DA 226 No Fault DA 226 Other (identify) Juvenile Emancipation CHILDREN INVOLVED IN THIS CASE (if applicable) Last Name First Name Middle Name Date of Birth Relationship 1. 2. 3. 4. 5. 6. 7. 8. Does this family have any other current or past case(s) in the Clark County Family Court or Juvenile Court? YES NO Your Printed Name Your Signature Date American LegalNet, Inc. www.FormsWorkFlow.com