JUSTICE COURT, HENDERSON TOWNSHIP CLARK COUNTY, NEVADA Name: Address: CASE NO. Plaintiff, DEPT NO. vs AFFIDAVIT OF COMPLAINT Name: SMALL CLAIMS Address: Defendant. STATE OF NEVADA COUNTY OF CLARK ) ) __________________________________________________________, being duly sworn, states: that the Defendant owes the Plaintiff the sum of plus court costs for that demand for payment has been made; the Defendant refuses to pay; that the Defendant either resides, works or does business in the Henderson Township, County of Clark, State of Nevada. SUBSCRIBED AND SWORN to before me this day of , PLAINTIFF’S Signature Plaintiff’s Telephone Number: Defendant’s Telephone Number: NOTARY PUBLIC / DEPUTY CLERK OR: ONE OF THE FOLLOWING: Per NRS 53.045 (a) If executed in this state (Nevada): I declare under penalty of perjury that the foregoing is true and correct. Executed on (Date) (Signature) (b) If executed outside of this state (Nevada): I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. Executed on (Date) (Signature) SUMMONS & ORDER TO APPEAR NOTICE: YOU HAVE BEEN SUED. THE COURT MAY DECIDE AGAINST YOU WITHOUT YOUR BEING HEARD UNLESS YOU APPEAR ON THE FOLLOWING DATE. YOU ARE HEREBY ORDERED TO APPEAR FOR TRIAL ON THE PLAINTIFF’S CLAIM AT: HENDERSON JUSTICE COURT - 243 WATER STREET - HENDERSON, NEVADA 89015 - (702) 455-7978 day of , 20 , at the hour of In Dept. # and on the present any defense you may have. You are further notified that in the event you do not appear, judgment will be given against you in the amount claimed due by the Plaintiff, which may result in the garnishment of wages and the seizure of property. PLEASE BRING WITH YOU ALL WITNESSES, AN ORIGINAL AND 2 COPIES OF ANY EVIDENCE, RECEIPTS OR BOOKS NECESSARY TO PROVE YOUR CASE. PLEASE CONTACT COURT TO CONFIRM COURT DATE. Henderson JC Rev. 02/02 APPROPRIATE COURTROOM ATTIRE REQUIRED NO SHORTS, HALTER TOPS OR TANK TOPS SHOES ARE REQUIRED (NO FOOD, DRINK OR SMOKING PERMITTED) COURT COSTS CONSTABLE/PS FEES TOTAL $ $ $ American LegalNet, Inc. www.USCourtForms.com AFFIDAVIT OF SERVICE STATE OF NEVADA COUNTY OF CLARK ) ) ss. ) _________________________________________________________, being duly sworn, states: that at all times herein Affiant was and is a citizen of the United States, over 18 years of age, not a party to or interested in the proceedings in which this Affidavit is made. That Affiant received a copy of the Affidavit of Complaint and Summons and Order to Appear on the day of day of , 20 , 20 , and served the same on this , by: (Affiant must complete the appropriate paragraph.) 1. Delivering and leaving a copy with the Defendant at: (state address) by personally delivering and leaving a copy with 2. Serving the Defendant , a person of suitable age and discretion residing at the Defendant=s usual place of abode located at: (state address) SUBSCRIBED AND SWORN to before me this Signature of Person Making Service , ___________ day of NOTARY PUBLIC Phone Number: Date: OR: ONE OF THE FOLLOWING: Per NRS 53.045 (a) If executed in this state (Nevada): I declare under penalty of perjury that the foregoing is true and correct. Executed on (Date) (Signature) (b) If executed outside of this state (Nevada): I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. Executed on (Date) (Signature) NOTATIONS American LegalNet, Inc. www.USCourtForms.com