JUSTICE COURT, LAS VEGAS TOWNSHIP Clark County, Nevada Case No. Department No. SMALL CLAIMS COMPLAINT Select Case Type: Individual Plaintiff Business Plaintiff State or County Agency Plaintiff NRS604(A) Complaint (Payday Loans 226 requires Defaulted Loan Worksheet as page #2, Proof of Debt and Repayment Offer Letter) NRS97 (A) Complaint 226 (Bought/Sold Credit Card Debt 226 requires last 4 digits of card issuers in the Affidavit) Inmate suing State of Nevada ex rel Department of Corrections Inmate suing any party except State of Nevada ex rel Department of Corrections Na me and Address of Plaintiff(s): Plaintiff(s)222 Email Address : Plaintiff(s)222 Telephone Number : VERSUS Name and Address of Defendant(s) : Defendant(s)222 Telephone Number : STATE OF NEVADA ) COUNTY OF CLARK ) I, (insert your name), being first duly sworn, deposes and says: That the defendant is indebted to the plaintiff in the sum of $; that the reason for this indebtedness is: ; that this affiant has demanded payment of the sum; that the defendant refuses to pay the same; that the defendant(s) is a resident of, does business in, or is employed in Las Vegas Township, in the County of Clark, State of Nevada; that affiant resides at the above address. * * * * * * * * * * * Signature of Affiant Dated Print Name Attorney for You M UST h a v e this a f fid a vi t not a ri z e d ( b l o ck o n t h e l e ft ) or s i gn the u n s w orn d e c l a r a ti o n p e r NRS 53 . 0 4 5 ( b l o ck o n t h e r i g ht ) : SUBSCRIBED AND SWORN to before me this day, 20 . (Notary Signature) NOTARY PUBLIC in and for the County of, State of . OR: UNSWORN DECLARATION: Per NRS 53.045 223I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct." Date Signature Typed or printed name SUMMONS & ORDER TO APPEAR NOTICE: YOU HAVE BEEN SUED. THE COURT MAY DECIDE AGAINST YOU WITHOUT YOUR PRESENCE UNLESS YOU APPEAR ON THE FOLLOWING DATE. You are hereby ordered to appear for trial on the Plaintiff222s claim at the Justice Court, Las Vegas Township located at: CLARK COUNTY REGIONAL JUSTICE CENTER, 200 LEWIS AVE, LAS VEGAS, NV 89101 ONAT THE HOUR OF COURTROOM and present any defense you may have. You must arrive 30 minutes before your trial time to check in with the clerk. A mediator will be available in the courtroom prior to your trial should you wish to mediate this matter. You are further notified that in the event you do not appear, Default Judgment can be entered against you in the amount claimed due by the Plaintiff, which can result in the garnishment of wages and 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. APPROPRIATE COURTOOM 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. Revised /17 American LegalNet, Inc. www.FormsWorkFlow.com