PROTECTION ORDER ­ DOMESTIC VIOLENCE RETURN OF SERVICE Case No. ____________________ Dept. No. ____________________ __________________________________________________, (Name) Applicant, VS. IN THE JUSTICE COURT OF __________TOWNSHIP COUNTY OF ___________, STATE OF NEVADA OR __________________________________________________, (Name) Adverse Party. IN THE ______________ JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA, IN AND FOR THE COUNTY OF ___________________________________ TYPE OF ORDER SERVED USE SEPARATE RETURN OF SERVICE FORM FOR PROTECTION ORDERS OTHER THAN DOMESTIC VIOLENCE The Order shall be served by the constable OR by a deputy; OR by the sheriff of the county where the defendant is found, OR by a deputy, OR by any person who is not a party and who is over 18 years of age. I HEREBY CERTIFY THAT ON ________________________________ I RECEIVED: (DATE) Temporary Protection Order­Domestic Violence Extended Protection Order-Domestic Violence Motion/Notice for Hearing - Domestic Violence Protection Order Order for Hearing to Extend, Modify or Dissolve Domestic Violence-Protection Order Foreign Order (describe in terms of State/County/City & Court Issued from): Other (describe): __________________________________________________________________________________________ I DECLARE UNDER PENALTY OF PERJURY THAT I: PERSONALLY SERVED the same upon the Adverse Party/Applicant__________________________________________, (Name) on _______________________ at _____________ , who identified himself/herself by or with:__________________________, (Date) (Time) (Type of Identification) at (location): ________________________________________________________________________________________, City of ________________________________________, County of _________________________, State of Nevada. NOTE TO LAW ENFORCEMENT: Protection Order must be served personally upon the Adverse Party and may not be left with a member of the household. INFORMED THE ADVERSE PARTY of the specific terms and conditions of the Order, and that a violation of the Order will result in his/her arrest; the location of the Court that issued the Order and the hours during which he/she may obtain a copy of the Order; and the date and time set for hearing. ATTEMPTED TO SERVE same on: _______________________________, _________________________________, and ____________________________. The Adverse Party/Applicant was not found and service was NOT effected. SIGNATURE (Officer/Person Serving Order/ID Number) Print Name (Officer/Person Serving Order) SIGNATURE (Adverse Party/Witness, if applicable) Print Address (Officer/Person Serving Order) Print Name and Address (Adverse Party/Witness) American LegalNet, Inc. www.FormsWorkFlow.com