Fillable COURT CODE: CERT Self-Represented DISTRICT COURT CLARK COUNTY, (Family Law Self Help Center)

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COURT CODE: CERT Self-Represented DISTRICT COURT CLARK COUNTY, (Family Law Self Help Center)

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© 2018 Family Law Self-Help Center
Page 1 of 3 – Certificate of Mailing (4-6 Children)
COURT CODE: CERT
Your Name:
Address:
City, State, Zip:
Telephone:
Email Address:
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Guardianship of the:
Person
Estate
Person and Estate
of:
___________
_________________________,
___________
_________________________,
___________
_________________________,
___________
_________________________,
___________
_________________________,
___________
_________________________
(
name of children who need a guardian)
Proposed Protected Minors.
CASE NO.: ____________________
DEPT: ____________________
CERTIFICATE OF MAILING FOR THE
PETITION FOR APPOINTMENT OF GUARDIANS
I HEREBY CERTIFY that I served the: ( check all that apply)
Petition for Appointment of Guardian
Citation to Appear and Show Cause
Other: ________________________________
on (month)_____________________ (day)_____, 20___, by depositing a copy of the same in
the U.S. Mail, enclosed in sealed envelopes, prepaid Certified Mail, Return Receipt Requested,
addressed to:
Page 2 of 3 – Certificate of Mailing (4-6 Children)
Relatives / Required Notices:
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Page 3 of 3 – Certificate of Mailing (4-6 Children)
If the children receive or have received Medicaid, check the following box and mail to:
Director of the Department of Health and Human Services
4126 Technology Way, Suite 100
Carson City, Nevada 89706-2009
I declare under penalty of perjury under the law of the State of Nevada that the
foregoing is true and correct.
DATED (month) ________________________ (day) _______, 20___.
ATTACH THE SIGNATURE RECEIPTS (GREEN CARDS FROM THE
POST OFFICE) TO THIS FORM WHEN RECEIVED
(Signature)
(Printed Name)
/s/
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COURT CODE: CERT Self-Represented DISTRICT COURT CLARK COUNTY, (Family Law Self Help Center)

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Completed 15 January 2021

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