CIVIL COVER SHEET Washoe County, Nevada Case No. ____________________________________ (Assigned by Clerk’s Office) I. Party Information Plaintiff(s) (name/address/phone): Defendant(s) (name/address/phone): DOB: DOB: Attorney (name/address/phone): Attorney (name/address/phone): II. Nature of Controversy (Please check applicable bold category and applicable subcategory, if appropriate) Arbitration Requested Civil Cases Real Property Landlord/Tenant - LT Unlawful Detainer - UD Title to Property Foreclosure - FC Liens - LE Quiet Title - QT Specific Performance - SP Torts Negligence Negligence – Auto - VP Negligence – Medical/Dental - MD Negligence – Premises Liability -SF (Slip/Fall) Negligence – Other - NO Other Real Property - RO Partition - PT Planning/Zoning - PZ Probate Other Civil Filing Types Summary Administration - SU Construction Defect - CF General Administration - FA Chapter 40 General Breach of Contract Building & Construction - BC Insurance Carrier - BF Commercial Instrument - CI Other Contracts/Acct/Judg. - CO Collection of Actions - CT Employment Contract - EC Guarantee - GU Sale Contract - SC Uniform Commercial Code - UN Set Aside Estates - SE Trust/Conservatorships Individual Trustee - TR Corporate Trustee - TM Other Probate - OP Intentional Misconduct Torts/Defamation(Libel/Slander)-DF Interfere with Contract Rights - IR Employment Torts(Wrongful Term)-WT Other Torts - TO Anti-trust - AI Fraud/Misrepresentation - FM Insurance- IN Legal Tort- LG Unfair Competition - UC Condemnation/Eminent Domain-CD Special Administration - SL Product Liability Product Liability/Motor Vehicle-VH Other Torts/Product Liability - PL Civil Petition for Judicial Review Other Administrative Law - AO Department of Motor Vehicles-DM Worker’s Compensation Appeal-SI Appeal from Lower Court (also check applicable civil case box) Transfer from Justice Court - TJ Justice Court Civil Appeal - CA Civil Writ Other Special Proceeding - SS Other Civil Filing Compromise of Minor’s Claim - CM Conversion of Property - CN Damage to Property - DG Employment Security - ES Enforcement of Judgment - EJ Foreign Judgment – Civil - FJ Other Personal Property - PO Recovery of Property - RE Stockholder Suit - ST Other Civil Matters – GC Confession of Judgment - CJ Petition to Seal Criminal Records-PS Out of State Commission - OS III. Business Court Requested (If you check a box below, you must check an additional box above to determine case type.) NRS Chapters 78-88 Commodities (NRS 90) Securities (NRS 90) Date Investments (NRS 104 Art. 8) Deceptive Trade Practices (NRS 598) Trademarks (NRS 600A) Enhanced Case Mgmt/Business Other Business Court Matters Signature of initiating party or representative See other side for family-related case filings. Nevada AOC – Planning and Analysis Division 2JDC 01/2007 American LegalNet, Inc. www.FormsWorkFlow.com Form PA 201 Rev. 2.4E 1 SECOND JUDICIAL DISTRICT COURT COUNTY OF WASHOE, STATE OF NEVADA 2 3 AFFIRMATION Pursuant to NRS 239B.030 4 The undersigned does hereby affirm that the preceding document, 5 6 7 (Title of Document) 8 9 filed in case number: 10 Document does not contain the social security number of any person 11 -OR- 12 Document contains the social security number of a person as required by: 13 A specific state or federal law, to wit: 14 ______________________________________________________ (State specific state or federal law) 15 16 -or- 17 For the administration of a public program 18 -or- 19 For an application for a federal or state grant 20 -or- 21 Confidential Family Court Information Sheet (NRS 125.130, NRS 125.230 and NRS 125B.055) 22 23 24 Date: (Signature) 25 26 (Print Name) 27 28 (Attorney for) Affirmation Revised December 15, 2006 American LegalNet, Inc. www.FormsWorkFlow.com