JUSTICE COURT , HENDERSON TOWNSHIP CLARK COUNTY, NEVADA Name: Address: CASE NO. _____________________________ PLAINTIFF/LANDLORD, DEPT. NO. ________________________ vs Name: AFFIDAVIT FOR HEARING Address: SUMMARY EVICTION / RETURN OF PROPERTY DEFENDANT/TENANT(S). I have been served with a Five Day Notice and request a hearing for the following reason: PLEASE CHECK THE APPROPRIATE REASON. [ ] I am not in default of the rent. Rent paid on: . [ ] I attempted to pay the rent on in the sum of and it was refused. [ ] I have been locked out of the premises and the landlord is holding my property in lieu of rent. [ ] Other: Defendant/Tenants Signature Address Phone Number City/State/Zip Code NOTARIZED SIGNATURE OR DECLARED UNDER PENALTY OF PERJURY SUBSCRIBED AND SWORN to before me this I DECLARE UNDER PENALTY OF PERJURY under the law ______ day of , of the State of Nevada that the foregoing is true and correct. _____________________________________________________________________ NOTARY PUBLIC / DEPUTY CLERK (SIGNATURE UNDER PENALTY OF PERJURY) EXECUTED ON: ____________________________________________________ ** Should the Landlord choose to proceed by way of formal Complaint, you will be served with the Complaint, Summons and Notice of Hearing by the Landlord or their Attorney** FOR COURT USE ONLY NOTICE OF HEARING THIS MATTER IS SET FOR THE __________ DAY OF ______________________________, 20_____ AT ___________ .M. IN DEPARTMENT NO: ______ LOCATED AT 243 WATER STREET, HENDERSON, NEVADA 89015 (702) 455-7978 DATE: CLERKS INITIALS: Copy of Affidavit/Notice of Hearing given to Plaintiff/Landlord (at the counter). Copy of Affidavit/Notice of Hearing mailed to Plaintiff/Landlord. Copy of Affidavit/Notice of Hearing mailed to Defendant/Tenant(s). Landlord notified by telephone of hearing date/time. Tenant(s) notified by telephone of hearing date/time. NRS 40.253 requires a copy of the Tenants Affidavit be provided to the Landlord or Agent to avoid non-admittance to the premises. PROPER ATTIRE IS REQUIRED. NO TANK TOPS, HALTER TOPS, OR SHORTS ARE ALLOWED IN THE COURTROOM. JC Henderson Rev. 07/04