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 NON-PAYMENT OF RENT I,________________________, state: 1. I am the landlord or agent of a 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 ______________________________________________________________, Apartment Landlord Affidavit/Declaration of Landlord for Summary Eviction for Nonpayment of Rent Form #8 1 of 4 ©2006 Nevada Supreme Court Revised: April 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com on ________________, 20____, with periodic rental payments reserved by the month or for a shorter period of time. The following items apply: _____ A. Tenant paid a security deposit of $_____________. _____ B. Tenant paid a cleaning deposit of $_____________. _____ C. Tenant paid a rent deposit of $___________. _____ D. The rental payment is $___________ per month/week. _____ E. Date rent was due __________________________. _____ F. Date rental payment delinquent ___________________. _____ G. Length of time without paying rent ____________________. _____ H. Total amount of rent due $___________________. _____ I. The Tenant does receive a subsidy from a Public Housing Authority. _____ J. The Tenant does not receive a subsidy from a Public Housing Authority. 3. That the periodic rental payments have not been waived or altered by a written agreement of any kind. 4. That the above-named tenant is in arrears on rent and that notice has been served on the tenant in accordance with the provisions of Nevada Revised Statutes, Chapter 40, as amended, a copy of which Notice is attached hereto and incorporated herein. 5. That more than five (5) days have elapsed since the service of the Notice as aforesaid, but the above-named tenant has refused, and still refuses, to vacate and quit the above-named rental unit. WHEREFORE, I pray for an order of this court, directed to the sheriff/constable of _________________________ Township, ordering the above-named tenant from the abovenamed rental unit, as provided for in Nevada Revised Statutes, Chapter 40. Apartment Landlord Affidavit/Declaration of Landlord for Summary Eviction for Nonpayment of Rent Form #8 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 Nonpayment of Rent Form #8 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 Nonpayment of Rent Form #8 4 of 4 ©2006 Nevada Supreme Court Revised: April 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com