Justice Court, Las Vegas Township CLARK COUNTY, NEVADA Name: CASE NO. Address: AFFIDAVIT OF COMPLAINT Plaintiff, SMALL CLAIMS ---vs--- Name: Address: Defendant, STATE OF NEVADA ) COUNTY OF CLARK ) , being duly sworn, states: that the Defendant owes the Plaintiff the sum of $ for that demand for payment has been made; the Defendant refuses to pay; that the Defendant either resides, works or does business in the Las Vegas Township, County of Clark, State of Nevada. SUBSCRIBED AND SWORN to before me this day of , PLAINTIFF Phone Number: NOTARY PUBLIC 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) 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 Plaintiffs claim at the Justice Court, Las Vegas Township located at: 200 SOUTH THIRD STREET, CLARK COUNTY COURTHOUSE, DEPT. NO. , COURTROOM NO. ON , AT THE HOUR OF and present any defense you may have. You are further notified that in the event you do not appear, Default 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 BOOK, NECESSARY TO PROVE YOUR CASE. APPROPRIATE COURTROOM ATTIRE REQUIRED. NO SHORTS, HALTER OR TANK TOPS SHOES ARE REQUIRED. (NO FOOD OR DRINK PERMITTED) NO SMOKING IN THE COURTHOUSE CHILDREN MUST REMAIN QUIET >>>> 2 Justice Court, Las Vegas Township CLARK COUNTY, NEVADA AFFIDAVIT OF SERVICE STATE OF NEVADA ) ) ss COUNTY OF CLARK ) , 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 , , and served the the same on this day of , by: (Affiant must complete the appropriate paragraph.) 1. Delivering and leaving a copy with the Defendant at: (state address) 2. Serving the Defendant by personally delivering and leaving a copy with , person of suitable age and discretion residing at the Defendants usual place of abode located at: (state address) 3. Personally depositing a copy in a mailbox of the United States Post Office, enclosed in a sealed envelope, postage prepaid, certified or registered mail, return receipt requested, addressed to the Defendant at: (For valid service a copy of the signed return receipt must be attached hereto). SUBSCRIBED AND SWORN to before me this day of , Signature of Person Making Service Phone Number: NOTARY PUBLIC in and for said County and State 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: