JUSTICE COURT, LAS VEGAS TOWNSHIP CLARK COUNTY, NEVADA VICTIM INFORMATION WORKSHEET Business Name: ___________________________________________________________ AKA (if applicable): ___________________________________________________________ Address: ___________________________________________________________ City: ___________________ State: ____________ Zip Code: ______________ Business Telephone Number: _________________________________________ Business Fax Number: _________________________________________ Business E-Mail Address (if applicable): _________________________________________ Business Web Address (if applicable): _________________________________________ Authorized Agent for Plaintiff: _________________________________________ Direct Telephone Number for Authorized Agent: ____________________________________ PLEASE ANSWER THE FOLLOWING QUESTIONS: (1) Does this business have a prior relationship with the Defendant ? (For example, is the Defendant a former employee/customer/neighboring business owner/etc.?)
Yes. (Please describe the relationship.) __________________________________ ______________________________________________________________________
No. (2) Have there been any other court actions between your business and the Defendan t?
Yes. (Please describe the prior court actions.) ____________________________ ______________________________________________________________________
No. (3) Are there specific employees and/or customers who are the focus of the harassment?
Yes. (Please list the names and job titles, if applicable, of all individuals.) ______________________________________________________________________ ______________________________________________________________________
No. (4) Is the business being represented by an attorney who will appear in this case?
Yes. NAME: _____________________________________________________ ADDRESS: _____________________________________________________ PHONE: _____________________________________________________
No. CONFIDENTIAL 1