Justice Court, Henderson Township CLARK COUNTY, NEVADA Name: Address: Telephone: Plaintiff, ---vs--- Name: Address: Telephone: Defendant, CASE NO. DEPT NO. AFFIDAVIT OF COMPLAINT SMALL CLAIMS STATE OF NEVADA ) COUNTY OF CLARK ) , being duly sworn, states: that the Defendant owes the Plaintiff the sum of $ ; that the reason for this indebtedness is: ; that demand for payment has been made; that the Defendant refuses to pay; and that the Defendant RESIDES, DOES BUSINESS, or IS EMPLOYED IN THE HENDERSON TOWNSHIP, County of Clark, State of Nevada. Pursuant to NRS 53.045, I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. Date: Affiant222s Signature SUMMONS & ORDER TO APPEAR NOTICE: YOU HAVE BEEN SUED. THE COURT MAY DECIDE AGAINST YOU WITHOUT YOUR CASE BEING HEARD UNLESS YOU APPEAR ON THE FOLLOWING DATE. YOU ARE HEREBY ORDERED TO APPEAR FOR TRIAL ON THE PLAINTIFF222S CLAIM AT: HENDERSON JUSTICE COURT HENDERSON, NEVADA 89015 (702) 455-7980 on the day of, 20, at the hour of a.m. in Dept. #for the purpose of mandatory mediation prior to a hearing where you may present any defense you may have. Please be advised that all parties who appear on the scheduled court date must be authorized to potentially enter into binding agreements throughout the mediation process. You are further notified that in the event you do not appear on time, 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. IT IS MANDATORY TO BRING WITH YOU ALL WITNESSES, AN ORIGINAL AND 2 COPIES OF ANY EVIDENCE, RECEIPTS OR BOOKS NECESSARY TO PROVE YOUR CASE. INDIVIDUAL PIECES OF EVIDENCE SHOULD BE ORGANIZED AND CLEARLY MARKED FOR REFERENCE FOR THE COURT. PLEASE CONTACT COURT TO CONFIRM COURT DATE. H.Jct. //18 APPROPRIATE COURTROOM ATTIRE REQUIRED . NO SHORTS, HALTER TOPS OR TANK TOPS. SHOES ARE REQUIRED. NO FOOD, DRINK OR SMOKING PERMITTED . CHILDREN MU ST REMAIN QUIET. COURT COSTS $ CONSTABLE/PS FEES $ TOTAL $ American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT OF SERVICE STATE OF NEVADA ) :ss COUNTY OF CLARK ) 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 proceeding in which this affidavit is made. That affiant received copy(ies) of the Affidavit of Complaint Small Claims on the day of , and served the same on the day of , by: (Affiant must complete the appropriate paragraph) 1.Delivering and leaving a copy with the Defendant at (address) . 2.Serving the Defendant by personally delivering and leaving a copy with , a person of suitable age and discretion residing at the Defendant222s usual place of abode located at (address): (Use paragraph 3 for service upon agent, completing A or B) 3.Serving the Defendant by personally delivering and leaving at: (address) . a.With as , an agent lawfully designated by statute to accept service of process; b.With , pursuant to NRS 14.020 as a person of suitable age and discretion at the above address, which address is the address of theresident agent as shown on the current certificate of designation filed with the Secretary of State. 4.You must obtain an Order from the Judge prior to service by mail of an Affidavit of Complaint. Personally depositing a copy in a mail box of the United States Post Office, enclosed in a sealed envelope postage prepaid (check appropriate method): Ordinary mail Certified mail, return receipt requested Registered mail, return receipt requestedaddressed to the Defendant at Defendant222s last known address which is (address): (For valid service by mail, a copy of the Certificate of Mailing or Return Receipt must be attached hereto.) Pursuant to NRS 53.045, I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. Date: Phone Number: Signature of Person Making Service Printed Name of Person Making Service NOTATIONS American LegalNet, Inc. www.FormsWorkFlow.com