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:________________ ORDER REGARDING ILLEGAL LOCKOUT OR UTILITY SHUT-OFF IT IS HEREBY ORDERED that the Tenant’s request for relief is: _____ DENIED, and _____ Although the Tenant did not prevail, the Court hereby waives the assessment of costs of fees against the Tenant. _____ Tenant shall be assessed $_____________ in costs and fees for failure to prevail in this case. Apartment Court Order Regarding Illegal Lockout or Utility Shut-off Form #19 Page 1 of 2 ©2006 Nevada Supreme Court Revised: April 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com OR _____ GRANTED, and Tenant is entitled to the following relief: _____ Statutory damages in the amount of $1,000.00. _____ Additional damages in the amount of $____________. _____ No damages. AND LANDLORD IS HEREBY ORDERED TO RESTORE _____ Access to the premises. _____ All utilities and essential services that were previously terminated; and _____ LANDLORD IS HEREBY ENJOINED FROM COMMITTING FURTHER VIOLATIONS OF NRS 118A.390. IF LANDLORD COMMITS ANY FUTURE VIOLATIONS, LANDLORD MAY BE HELD IN CONTEMPT OF COURT; and _____ Landlord shall be assessed $_____________ in costs and fees for failure to prevail in this case. _____ The Court hereby waives the assessment of costs and fees against Landlord. IT IS SO ORDERED. ______________________ DATED Apartment Court Order Regarding Illegal Lockout or Utility Shut-off Form #19 _______________________________ JUSTICE OF THE PEACE Page 2 of 2 ©2006 Nevada Supreme Court Revised: April 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com