IN THE JUSTICE COURT OF __________________________ TOWNSHIP IN AND FOR THE COUNTY OF _________________, STATE OF NEVADA Name: Address: Phone: ______________________ ______________________ ______________________ ______________________ Landlord/Plaintiff vs. Name: Address: Phone: CASE NO: ________________ _____________________ _____________________ _____________________ _____________________ Tenant/Defendant DEPT. NO:________________ LANDLORD’S AFFIDAVIT/DECLARATION FOR SUMMARY EVICTION FOR BREACH I, __________________________, state: 1. I am the landlord of certain dwellings or apartments within the jurisdiction confines of ______________________________________ Township, ____________________________ County, Nevada. 2. I rented a certain dwelling or apartment to_______________________________ ________________________________________________________________, located at ________________________________________________________ on ______________, 20____ for an original period of ___________, terminating on or transferring to a periodic tenancy on _______________, 20____. A copy of the written rental agreement, if any, is attached hereto. Apartment 1 of 4 Landlord Affidavit/Declaration of Landlord for Summary Eviction for Breach Form #9 ©2006 Nevada Supreme Court Revised: April 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com 3. That the above-named tenant has not complied with the conditions(s) or covenant(s) of the rental agreement or with the obligations of the tenant as enumerated in Nevada Revised Statutes, Chapter 118A, as of ______________________________, 20____, as set forth below: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ _______________________________________________________________. 4. That the termination and surrender of the rental unit was to have taken place on or before _______________, 20____. That legal Notice has been served upon the tenant pursuant to the provisions of NRS 40.280, on ________________, 20____. A copy of the Notice is attached hereto and incorporated by this reference. 5. That compliance with the breached covenant(s) and conditions(s) has not taken place or cannot be ascertained and that termination and surrender of the rental unit has not taken place and the tenant continues in possession of the rental unit unlawfully. 6. That the attached rental agreement and accompanying rules were issued to the tenant as prescribed by Chapter 118A, and no changes have been made to either document except by compliance with Chapter 118A. 7. Affiant requests that the court enter an order for the summary eviction of the tenant from the premises and the sheriff/constable be ordered to remove the tenant within twenty-four (24) hours after receipt of the court order. Apartment Landlord Affidavit/Declaration of Landlord for Summary Eviction for Breach Form #9 2 of 4 ©2006 Nevada Supreme Court Revised: April 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com AFFIDAVIT/DECLARATION OF SERVICE On __________________, I served the following document: (Date) ______________________________________________________________________ (Name of Document) at the following time ___: _______ AM / PM and in the following manner: _____ 1. By delivering a copy to the tenant(s) personally, in the presence of a witness. (Server, Tenant & Witness Must All Sign). __________________ Signature of Server ____________________ Signature of Tenant ____________________ Signature of Witness __________________ Print Name of Server ____________________ Print Name of Tenant ____________________ Print Name of Witness _____ 2. Because the tenant(s) were absent from their place of residence or from their usual place of business, by leaving a copy with __________________________, a person of suitable age and discretion, at either place and mailing a copy to the tenant(s) at their place of residence or place of business. (Attach United States Postal Service Certificate of Mailing). _____ 3. Because the place of residence or business could not be ascertained, or a person of suitable age or discretion could not be found there, by posting a copy in a conspicuous place on the property, delivering a copy to a person there residing, if the person could be found, and mailing a copy to the tenant(s) at the place where the property is situated. (Attach United States Postal Service Certificate of Mailing). Apartment Landlord Affidavit/Declaration of Landlord for Summary Eviction for Breach Form #9 3 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 Landlord Affidavit/Declaration of Landlord for Summary Eviction for Breach Form #9 4 of 4 ©2006 Nevada Supreme Court Revised: April 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com