1 2 Case No. _____________________ Dept. No._____________________ 3 IN THE JUSTICE COURT OF _____________ TOWNSHIP 4 COUNTY OF __________________, STATE OF NEVADA 5 6 7 8 9 _____________________________________, ) Employer,) ) ) ) vs. ) _____________________________________, ) Adverse Party.) CERTIFICATE FOR REGISTRATION OF OUT-OF-STATE ORDER RE: WORKPLACE HARASSMENT (NRS 33.310) 10 11 According to NRS 33.310, an employer or an authorized agent of an employer may 12 13 14 register a Temporary or Extended Order for Protection Against Harassment in the Workplace issued by the court of another state by presenting a certified copy of the Order to the Clerk of 15 the Court in a judicial district in which the employer believes that enforcement may be 16 necessary. 17 A Temporary or Extended Order for Protection Against Harassment in the Workplace 18 that is registered has the same effect and must be enforced in like manner as such an Order 19 issued by a Court of this State. 20 On _________________, 20____, this Court received a copy of an Order for 21 Protection Against Harassment in the Workplace from the _____________ Court in the State 22 23 24 25 of _______________, Case Number _______________. This paperwork was submitted by: NAME OF EMPLOYER OR AUTHORIZED AGENT: _________________________________________________ Form B-26 Certificate for Registration of Out-of-State Order ©2007 Nevada Supreme Court June 30, 2007 Page 1 of 2 1 The out-of-state order: 3 4 5 6 7 8 9 Indicates an expiration date of ___________________. ͕ 2 ͕ Does not indicate any expiration date. The out-of-state Order was registered with this Court on the following date: ___________________________________________________________________________ All pertinent documentation, including this Certificate and the out-of-state Order, was forwarded to the following law enforcement agencies, on the following dates: LAW ENFORCEMENT AGENCIES: ___________________________________ ___________________________________ ___________________________________ ___________________________________ DATE OF NOTIFICATION: _________________________________ _________________________________ _________________________________ _________________________________ 10 11 The Clerk of this Court will maintain a record of each order registered pursuant to NRS 33.310. 12 13 14 DATE OF THIS CERTIFICATE:_________________________________________ 15 16 DEPUTY CLERK SIGNATURE: _________________________________________ 17 18 19 20 21 22 23 24 25 Form B-26 Certificate for Registration of Out-of-State Order ©2007 Nevada Supreme Court June 30, 2007 Page 2 of 2