© 2020 Family Law Self-Help Center Request for Video Appearance
Page 2 of 2
If the IT department wants to test and verify the functionality of the party/witness’s
video conference connectivity with the Court’s IT department, the contact information of the
party or witness for the test is:
Name: _________________________________________
Email Address: __________________________________
Phone Number: __________________________________
DATED (today’s date) _________________________________
Submitted By: (Signature)_________________________________
Printed Name: _________________________________
CONSENT
(to be signed by the person who wants to appear by video)
By making this request for Audiovisual Transmission Equipment Appearance, the
undersigned agrees to be bound by the oath given by the Court Clerk over the video conference
connection and to be subject to the jurisdiction of this Court for purposes related to this
testimony. I certify that the video connection has been successfully tested at
http://bluejeans.com/111, prior to submitting this application.
Pursuant to NRS 53.045, I declare under penalty of perjury that the foregoing is true
and correct.
DATED (today’s date) _________________________________
(Signature of party or witness)_________________________________
Printed Name: _________________________________
/S/
/S/