Fillable CONTACT-INFORMATION FORM (Las Vegas Justice Court)

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CONTACT-INFORMATION FORM (Las Vegas Justice Court)

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Las Vegas Justice Court
Regional Justice Center
200 Lewis Avenue 2nd Fl.
P.O. Box 552511
Las Vegas NV 89155-2511
(702) 671-3116
Fax (702) 671-3183
http://www.lasvegasjusticecourt.us
CONTACT-INFORMATION FORM
1. PLEASE CHECK THE APPLICABLE BOX BELOW:
[ ] Plaintiff
[ ] Defendant
2. PRINTED NAME: _________________________________________________________________________
3. MAILING ADDRESS: __________________________________________________________________________________
______________________________________________________________________
______________________________________________________________________
4.
5. DECLARATION AND SIGNATURE:
I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct.
I further declare and acknowledge that I must complete an updated Contact-Information Form in the event that
any of the above information changes.
__________________ _____________________________________________________
Date Signature
PHONE NUMBERS: (If not applicable, please list as "N/A.")
HOME: ________________________ CELL: ________________________
EMAIL: _______________________________________________________________________________________________
Case Number:
_________________________
For Court Use Only:
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Completed 19 January 2021

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