Justice Court, Las Vegas Township County of Clark, State of Nevada DEFENDANT CONFIDENTIAL INFORMATION WORKSHEET HARM TO MINORS All information to be completed to the best of your ability Defendant’s Full Name: __________________________________________ A.K.A ________________________ Address: ________________________________________________________________________ City: __________________________ State: _______________________ Zip: ___________ [ ] Initial that you have read and understand the following: IF I AM UNABLE TO PROVIDE A VERIFIABLE ADDRESS FOR THE DEFENDANT OR THE DEFENDANT IS UNABLE TO BE SERVED USING THE ADDRESS I HAVE PROVIDED, I WILL BE RESPONSIBLE TO HAVE THE ORDER FOR PROTECTION PROPERLY SERVED. Home Phone: ______________________ Race: __________________ Cell Phone: _____________________ Speak English? Yes ___ No___ If No, what language? _____________________ Date of Birth or approximate age: _________________ Approximate Descriptors: Sex: M ____ F ____ Height: _______Weight: _______ Hair: _________ Eyes: ___________ Identifying Scars, Marks, Tattoos: ___________________________________ Social Security No. _______________________ Place of Birth: ___________________ Vehicle Make/Model /Year/License Plate __________________________________________ Employer Name: __________________________________ Schedule (days/hours worked): _________________ Employer Address and Phone No.: _____________________________________________________________ Are you aware of any other relevant court proceedings involving this person? Yes ___ No ____ If yes, please explain: ________________________________________________________________________ What is the Defendant’s relationship to the victim (i.e. friend, relative, neighbor etc.)? ___________________________ To your knowledge, is the Defendant a convicted sex offender? Yes __ No __ Is the Adverse Party likely to react violently when served? Is the Adverse Party likely to avoid service? Does the Adverse Party have access to weapons? If yes, in which State(s)? __________ Yes___ No___ Yes___ No___ Yes___ No___ COURT PERSONNEL ONLY: Defendant TPO ID # __________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ CONFIDENTIAL American LegalNet, Inc. www.USCourtForms.com