1 2 3 4 5 6 IN THE JUSTICE COURT OF __________________________ TOWNSHIP 7 IN AND FOR THE COUNTY OF _________________, STATE OF NEVADA 8 9 10 Name: Address: Phone: 11 12 13 vs. 14 Name: Address: 15 Phone: 16 17 18 ______________________ ______________________ ______________________ ______________________ Landlord/Plaintiff CASE NO: ________________ _____________________ _____________________ _____________________ _____________________ Tenant/Defendant DEPT. NO:________________ APPLICATION TO WAIVE FEES AND COSTS (Filing Fees/Service Only) 19 Pursuant to NRS 12.015, and based on the attached Affidavit, I request 20 permission from this Court to proceed without paying court costs or other costs and fees as 21 provided in NRS 12.015 because I lack sufficient financial ability. 22 23 I request the Court hold a hearing on this Application if the Court is inclined to deny same, so that I may testify as to my indigent status. Submitted by, 24 25 26 _________________________ Date _____________________________ Signature of Party 27 28 Apartment Landlord or Tenant Affidavit/Declaration in Support of Application to Waive Fees and Costs Form #37 1 of 1 _____________________________ Print Name of Party ©2006 Nevada Supreme Court Revised: April 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com