1 Code No. ____________________________ 2 Your Name: ____________________________ 3 Address: ____________________________ ____________________________ 4 Telephone: ____________________________ 5 In Proper Person 6 7 IN THE________ JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA 8 IN AND FOR THE COUNTY OF _________________ 9 10 ) , ) 11 Plaintiff(s), ) 12 vs ) ) CASE NO.: 13 ________________________________, ) 14 Defendant(s). ) DEPT NO.: ) 15 ________________________________ ) 16 17 ORDER REGARDING WAIVER OF FEES AND COSTS (Filing Fees/Service Only) 18 Upon consideration of _____________________________ s Application to 19 ( Plaintiff/Defendant) Proceed in Forma Pauperis and it appearing that there is not sufficient income, property or 20 resources with which to maintain the action and good cause appearing therefor: 21 22 __________ IT IS HEREBY ORDERED that _________________________s request to ( Plaintiff/Defendan) t 23 to waive fees and costs is GRANTE. ____________________________, shall bD e permitted to (Plaintiff/Defendant) 24 proceed In Forma Pauperis with this action as permitted by NRS 12.015. He/she shall proceed 25 without the prepayment of costs or fees or the necessity of giving security, and the Clerk of 26 27 Court shall file or issue any necessary writ, process, pleading, or paper without charge. The 28 Sheriff or other appropriate officer within this State shall make personal service of any necessary EXHIBIT R 1 American LegalNet, Inc. www.USCourtForms.com>>>> 2 1 writ, pleading, or paper without charge. If this party prevails in this action, the Court shall enter 2 an order pursuant to NRS 12.015 requiring the opposing party to pay into the Court, within five 3 (5) days, the costs which would have been incurred by the prevailing party, and those costs must 4 then be paid as provided by law. 5 ___________ IT IS HEREBY ORDERED that _______________________s request to waive 6 (Plaintiff/Defendant) 7 fees and costs is DENIED for the following reason: 8 A. ____________ The party is not indigent. 9 B. ____________ Other: _________________________________________________ __ 10 ________________________________________________________________________ _____ 11 DATED this______ day of _____________________,__________. 12 13 DISTRICT COURT JUDGE 14 Respectfully submitted: 15 (Your signature) 16 (Your name) 17 (Address) 18 19 20 (Telephone) (Check One) Plaintiff/ Defendant In Proper Person 21 /// 22 /// 23 /// 24 /// 25 /// 26 /// 27 /// 28 /// /// EXHIBIT R 2 American LegalNet, Inc. www.USCourtForms.com