IN THE JUSTICE COURT OF __________________________ TOWNSHIP IN AND FOR THE COUNTY OF _________________, STATE OF NEVADA Name: Address: Phone: ______________________ ______________________ ______________________ ______________________ Landlord/Plaintiff CASE NO: ________________ _____________________ _____________________ _____________________ _____________________ Tenant/Defendant DEPT. NO:________________ vs. Name: Address: Phone: AFFIDAVIT/DECLARATION IN SUPPORT OF MOTION TO STAY EVICTION ORDER I, _____________________________, (Name) state: 1. _____ 2. I am the tenant/co-tenant in the above-referenced matter. _____ A. An eviction order was granted by this court on ____________, 20____. OR _____ B. I anticipate, based on the attached notice of eviction, that I will be evicted on or before _____________________, 20____. Apartment Tenant Affidavit/Declaration in Support of Motion to Stay Eviction Order Form #27 1 of 4 ©2006 Nevada Supreme Court Revised: April 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com _____ 3. I received an eviction notice served _____ A. personally on _______________, 20____. OR _____ B. physically placed in a conspicuous place on ______________________, 20____ and mailed on ________________, 20____. _____ 4. _____ 5. _____ 6. I agree that I owe the amount of rent due. I do not agree that I owe the amount of rent due. _____ A. I do not contest the allegations contained in the Landlord's Affidavit. OR _____ B. 7. The eviction is for "no cause." I am not attempting to delay the proceedings by filing this motion, nor am I filing it for frivolous reasons. _____ 8. _____ 9. _____ 10. My rent is subsidized by a Public Housing Authority. My rent is not subsidized by a Public Housing Authority. Compelling reasons exist to delay the enforcement of any eviction order: (Explain your reasons why the eviction should be delayed)____________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ __________________________________________________________. Apartment Tenant Affidavit/Declaration in Support of Motion to Stay Eviction Order Form #27 2 of 4 ©2006 Nevada Supreme Court Revised: April 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com I swear the above is true. Signature:__________________________________ SUBSCRIBED AND SWORN to before me this ____ day of _________________, 20____. NOTARY PUBLIC OR DEPUTY CLERK _____________________________ OR THE FOLLOWING: Pursuant to NRS 53.045: "I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct." Executed on _____________, 20____ ______________________________ Signature ______________________________ Print Name Apartment Tenant Affidavit/Declaration in Support of Motion to Stay Eviction Order Form #27 3 of 4 ©2006 Nevada Supreme Court Revised: April 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com CERTIFICATE OF SERVICE Pursuant to NRCP 5(b) and JCRCP 5(b), I hereby certify that I am a nonparty over the age of 18 years, and that on ____________________________, 20____, I served a true and correct copy of the foregoing __________________________________________________________________, (Name of document that was served) addressed to: _______________________________________ _______________________________________ _______________________________________ _______________________________________ [] BY U.S. MAIL: I deposited for mailing in the United States mail, with postage fully prepaid, an envelope containing the above-identified document at _______________________________ (City and State), in the ordinary course of business. [] [] BY FACSIMILE TO: _______________________________ (FAX number). BY PERSONAL SERVICE: I personally hand delivered the above-identified document to the address/offices of the person named above. _______________________________ Signature of Server _______________________________ Print Name of Server Apartment Tenant Affidavit/Declaration in Support of Motion to Stay Eviction Order Form #27 4 of 4 ©2006 Nevada Supreme Court Revised: April 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com