PROTECTION ORDER DOMESTIC VIOLENCE RETURN OF SERVICE Case No. Dept. No. , IN THE JUSTICE COURT OF TOWNSHIP (Name) Applicant, COUNTY OF , STATE OF NEVADA OR VS. IN THE JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA, IN AND FOR THE , COUNTY OF (Name) Adverse Party. 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. N NOOTTEE TTOO LLAAWW EENNFFOORRCCEEMMEENNTT:: PPrrootteeccttiioonn OOrrddeerr m muusstt b bee sseerrvveedd ppeerrssoonnaallllyy uuppoonn tthhee AAddvveerrssee PPaarrttyy aanndd mmaayy nnoott bbee lleefftt w wiitthh aa mmeemmbbeerr ooff tthhee hhoouusseehhoolldd.. 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) Print Address (Officer/Person Serving Order) SIGNATURE (Adverse Party/Witness, if applicable) Print Name and Address (Adverse Party/Witness) American LegalNet, Inc. www.FormsWorkFlow.com